AccountId: 011433970860
ContactId: fd60f976-faca-477a-b325-711cbd75eb75
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 505809 ms
Total Talk Time (AGENT): 142053 ms
Total Talk Time (CUSTOMER): 210104 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/fd60f976-faca-477a-b325-711cbd75eb75_20250227T13:28_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, hi, my name is [PII]. Uh, so I'm here for a claim status.
[AGENT][NEUTRAL] OK, I can help you, [PII], um, what's the policy number?
[CUSTOMER][NEUTRAL] Uh, the, uh, the policy number here is 1070427.
[AGENT][POSITIVE] And a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yup, sure.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And date of birth?
[CUSTOMER][NEUTRAL] Yeah, OK. So the date of birth is [PII].
[AGENT][NEUTRAL] Alright thanks um for that information [PII] and you stated that you're checking for a claim status?
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] Alright, can you provide the data service and the charge for me please?
[CUSTOMER][NEUTRAL] Yeah, so the uh so the service here is [PII] and the total charge amount is $984.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what's the procedure code on the claim?
[CUSTOMER][NEUTRAL] Oh, OK, it's just give me a little sec. Let me just pull up the information here.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, so the procedure code here is 99285.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so I show the claim was receipt [PII].
[AGENT][NEUTRAL] And I show that it was processed.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] Is this the emergency room physician's charge?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is this the emergency room physician's charge?
[CUSTOMER][NEUTRAL] Uh, let, just let me check here. One second. Yeah, it's um, uh, emergency Medicine Services of Florida. It's for like you are asking for a facility, right?
[AGENT][NEUTRAL] No, I was just verifying to make sure I have the right claim. Is this where the ER physicians charge? Not the facility, but the ER physician.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so I'm showing that the maximum amount payable for this occurrence has been met and so the maximum benefit is is exhausted for this particular uh claim. I'm showing a claim number of 356.
[AGENT][NEUTRAL] 813 2.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And Alex, you can also check status online at [PII].
[AGENT][NEUTRAL] And did you have any other questions I can help with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, so the claim was denied for a maximum benefit, right?
[AGENT][POSITIVE] Correct. Met, yes.
[CUSTOMER][NEUTRAL] OK, uh, OK, so, uh, like, is, is it made by, uh, like by a dollar or, uh, is it?
[AGENT][NEUTRAL] It's up to $500 per occurrence, so it's $1 maximum per occurrence.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Accurs, OK. So like uh how many the patient has met, uh, do you have a data with it?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, how many that patient has, has met?
[CUSTOMER][NEUTRAL] Till now.
[AGENT][NEUTRAL] 500. It's 500 per current.
[CUSTOMER][NEUTRAL] 500 total?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Any other questions?
[CUSTOMER][NEUTRAL] Uh, no, like, basically, I have one more claim here in my system. Could you just help me with that one?
[AGENT][POSITIVE] All righty.
[AGENT][NEUTRAL] If we're the same patient?
[CUSTOMER][NEUTRAL] Uh, like I have to verify with that. No, uh, it's a different patient.
[AGENT][NEUTRAL] OK, give me one moment to complete this call and we can proceed, OK?
[CUSTOMER][NEUTRAL] Sure. Uh, so the, the call reference would be the same or a different one?
[AGENT][NEUTRAL] It's my name in today's date.
[CUSTOMER][NEUTRAL] Will be the same?
[AGENT][NEUTRAL] The call reference number is my name and today's date.
[CUSTOMER][NEUTRAL] OK, uh, for verification, can you just spell your name for me?
[AGENT][NEUTRAL] [PII] initial last name is [PII], and I'm ready for the next policy number, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, just give me a little sec.
[CUSTOMER][NEUTRAL] OK. So, uh, the next policy number here is 02509901. 0 sorry, 0, let me repeat one second again. It's 02509901.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, wait, just, it's, I think it's nothing, uh, uh, let me tell you the policy number one second it's 025099909.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, uh
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, what's the date of service in charge?
[CUSTOMER][NEUTRAL] And and your service is [PII].
[AGENT][NEUTRAL] And the total charge.
[CUSTOMER][NEUTRAL] Total charge is $533.
[AGENT][NEUTRAL] 533.
[CUSTOMER][NEUTRAL] Yep, 33.
[AGENT][POSITIVE] Thank you. OK.
[CUSTOMER][NEUTRAL] 533.
[AGENT][NEUTRAL] And you said [PII]?
[CUSTOMER][NEUTRAL] Yeah, uh, [PII], yes.
[AGENT][NEUTRAL] OK, I'm not showing that date of service on file for [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, just let me verify once again here if there is that we have built the claim or not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK. Uh, so, can, can you, uh, tell me the meaning like we haven't bill you the claim. So, uh, can you just tell me the mailing address for the billing?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] The zip code?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Sure. And uh is there any TFL or something?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] [PII]h, the filing limit for the claim.
[AGENT][NEUTRAL] To submit the claim if there's no timely filing limit.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] Anything else I can help with today, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Uh, no.
[AGENT][POSITIVE] Alrighty well thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Yeah, you too. Bye-bye.
[AGENT][NEUTRAL] Bye bye.