AccountId: 011433970860
ContactId: f7e51e69-53f9-4f0a-98c3-30c7c36dd489
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 529289 ms
Total Talk Time (AGENT): 122603 ms
Total Talk Time (CUSTOMER): 159871 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/f7e51e69-53f9-4f0a-98c3-30c7c36dd489_20250410T17:18_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm [PII] calling from Summit Radiology Services to check on a client status. Could you please help me with it?
[AGENT][NEUTRAL] Yeah, I'm happy to check on the claim today, [PII]. What's the patient's policy number?
[CUSTOMER][NEUTRAL] The patient's policy number is D as in.
[CUSTOMER][NEUTRAL] Delta 43732467.
[AGENT][NEGATIVE] Unfortunately, I can't pull the member with that number. Um, do you have their name or social?
[CUSTOMER][NEUTRAL] Yes, the patient's name is uh [PII].
[AGENT][NEUTRAL] I'm gonna need you to spell that for me, please.
[CUSTOMER][NEUTRAL] First name is [PII]
[CUSTOMER][NEUTRAL] And the last name is [PII]
[AGENT][POSITIVE] OK, one moment, thank you.
[AGENT][NEUTRAL] Do they live in the state of [PII]?
[CUSTOMER][NEUTRAL] Do they.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Are you asking for the provider's date?
[AGENT][NEUTRAL] Do you know where if the member lives in the state of [PII]?
[CUSTOMER][NEUTRAL] It's the.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] What is the date of birth?
[CUSTOMER][NEUTRAL] What is the
[CUSTOMER][NEUTRAL] The date of birth is [PII].
[AGENT][NEUTRAL] And then what's the date of service?
[CUSTOMER][NEUTRAL] The date of service is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And to build them out?
[CUSTOMER][NEUTRAL] And the bill amount is $312 even.
[AGENT][NEUTRAL] So it looks like we did receive a claim for the state of service claim was received on [PII].
[CUSTOMER][NEUTRAL] They claim was received.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Claim is processed on the [PII].
[CUSTOMER][NEUTRAL] The claim was processed on the [PII].
[AGENT][NEUTRAL] Claim was denied, the calendar maximum on diagnostic services has been met.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Could you please repeat the denied, uh, processed and denied date?
[AGENT][NEUTRAL] A claim was denied and processed on [PII].
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] 2
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, is the benefit exhausted in terms of visits are dollars?
[AGENT][NEUTRAL] Let me see if it.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] It looks like in terms of visits, the patient is allowed one per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Maximum number of visits are allowed.
[AGENT][NEUTRAL] Correct. It was not the dollar amount, it was the amount of visits.
[CUSTOMER][NEUTRAL] OK, um, uh, what is the maximum number of visits allowed?
[AGENT][NEUTRAL] The maximum per year is 3.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is this annual or monthly?
[AGENT][NEUTRAL] This is a calendar year.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mm, may I know when was the last CPT, uh, CPT paid last?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] It looks like the last benefit amount that was issued was for a date of service of [PII].
[CUSTOMER][NEUTRAL] OK. Could you please uh send me the copy of EOP through fax?
[AGENT][NEUTRAL] And what's the fax number?
[CUSTOMER][NEUTRAL] Yes, the fax number is [PII]. Attention to my name, [PII], last initial is [PII]
[AGENT][NEUTRAL] OK, [PII], is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, I'm sending that now. It should be there in about 5 minutes, [PII], OK?
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][POSITIVE] Yeah, sure, thank you.
[AGENT][NEUTRAL] Is there anything else?
[CUSTOMER][NEUTRAL] May I have the claim number?
[CUSTOMER][NEUTRAL] Yes. May I have the claim number?
[AGENT][NEUTRAL] Claim number is 3555.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] 963.
[CUSTOMER][NEUTRAL] OK, thank you. Um, could you please spell out your name?
[AGENT][NEUTRAL] My name is spelled [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] The agent.
[CUSTOMER][NEUTRAL] And the last name initial?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK. Thank you, [PII].
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] May I have the uh
[CUSTOMER][NEUTRAL] Uh, I need the call reference number please.
[AGENT][NEUTRAL] It's just gonna be my name with today's date.
[CUSTOMER][NEUTRAL] It's just
[CUSTOMER][POSITIVE] OK. Thank you, sir. Have a nice day.
[AGENT][NEUTRAL] You too bye bye.