AccountId: 011433970860
ContactId: f45828e6-7430-4c22-a449-f7c7c7363524
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 298820 ms
Total Talk Time (AGENT): 126863 ms
Total Talk Time (CUSTOMER): 82695 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/f45828e6-7430-4c22-a449-f7c7c7363524_20250324T18:41_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] calling for provider to check on additional information about the claim that has been denied. Please note this call will be monitored and recorded for quality and training purpose. How are you doing today?
[AGENT][POSITIVE] I'm doing well, thank you for asking. And how are you today?
[CUSTOMER][POSITIVE] Yeah, I'm doing good. Thank you so much for asking.
[AGENT][NEUTRAL] Good. Do you mind spelling your name for documentation purposes?
[CUSTOMER][NEUTRAL] Yeah, definitely. It's [PII]. It's a direct line.
[AGENT][NEUTRAL] And what is your name again?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] Thank you, [PII]. It would be my pleasure to help you with that claim information. Do you have the claim number available?
[CUSTOMER][NEUTRAL] Just a second, I'm looking into that.
[CUSTOMER][NEUTRAL] No, I don't have claim number.
[AGENT][NEUTRAL] What about a policy number for the patient?
[CUSTOMER][NEUTRAL] Yes, uh, policy number is 02536733.
[AGENT][NEUTRAL] And [PII], what is the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] is the last name. [PII] is the date of birth.
[AGENT][NEUTRAL] Alright thank you and what about a data service?
[CUSTOMER][NEUTRAL] [PII] with total charge on $353 even.
[AGENT][NEUTRAL] And the facility name please ma'am?
[CUSTOMER][NEUTRAL] Premier uh OBGYN of Minnesota.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm checking on that claim, bear with me just one second.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, and that is for the CPT is 992133641581025 and 84702?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you. And I can help you with that claim information.
[AGENT][NEUTRAL] I'm showing that we received that claim on [PII].
[AGENT][NEUTRAL] It was processed on.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And for that CBT 36415.
[AGENT][NEUTRAL] That is a non-covered procedure. Then a puncture is not covered.
[AGENT][NEUTRAL] By this policy, and then for the 99213.
[AGENT][NEUTRAL] 81025 and 84702, it was denied as the maximum benefit for that data service has been met.
[CUSTOMER][NEUTRAL] Oh, maximum benefits exhausted, right?
[AGENT][NEUTRAL] For that data service, yes ma'am.
[CUSTOMER][NEUTRAL] OK. So, could you please uh provide me, uh, per policy, how many visits for the member?
[AGENT][NEUTRAL] The maximum that we could pay per data service per day.
[AGENT][NEUTRAL] It is $50 and that is available 5 times per calendar year.
[CUSTOMER][NEUTRAL] OK. Could you please provide me the claim number?
[AGENT][NEUTRAL] The claim number is 357.
[AGENT][NEUTRAL] 1384.
[CUSTOMER][NEUTRAL] OK. So you stated that uh it is 36415 is non-covered and the patient's plan or provider's contract.
[AGENT][NEUTRAL] It's for the patient's plan.
[CUSTOMER][NEUTRAL] OK. Could you please uh provide me the call reference number?
[AGENT][NEUTRAL] The call reference number is my name and today's date, and I spell my name [PII].
[CUSTOMER][POSITIVE] Thank you so much for assisting me. Have a great day.
[AGENT][POSITIVE] It's been my pleasure to assist you with that claim status, [PII], and is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] All right. Well, thank you for calling APL [PII]. I hope you have a wonderful afternoon.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Thank you