AccountId: 011433970860
ContactId: 03db724c-8326-4cae-bb8a-374077c1687e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 551270 ms
Total Talk Time (AGENT): 186186 ms
Total Talk Time (CUSTOMER): 143752 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/03db724c-8326-4cae-bb8a-374077c1687e_20250320T18:17_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, hi, I was calling for updated claim status, please.
[AGENT][POSITIVE] OK, I'm happy to check on a claim for you today. Can I get the patient's policy number?
[CUSTOMER][NEUTRAL] Uh, sure, it's 024332161.
[AGENT][POSITIVE] All right. Thank you so much. And then if I could grab your name and a callback number?
[CUSTOMER][NEUTRAL] Uh, sure, it's, uh, my name is [PII] and the phone number is [PII].
[AGENT][POSITIVE] All right, thank you, [PII].
[AGENT][NEUTRAL] All right, let me pull this up here. I think I may have copied down too many numbers. Let me read this back. Uh 0243 and then 32161.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It was 024332161.
[AGENT][NEUTRAL] What's the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] It's uh [PII]. Date of birth is um [PII].
[AGENT][NEUTRAL] OK, we have one, we have a number off somewhere.
[AGENT][NEUTRAL] Do you by chance have
[CUSTOMER][NEUTRAL] Oh, I'm looking at.
[AGENT][NEUTRAL] Go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] I'm looking at her card um after so it looks like we have an extra digit is that what you're saying?
[AGENT][NEUTRAL] I think so, yes.
[CUSTOMER][NEUTRAL] OK, that first one isn't supposed to be there, so it's 02433261.
[AGENT][NEUTRAL] OK, there we go. That's OK. That's OK. I was trying different variations here. I like, I think we're off a number. Let me, all right, let me start over here cause I'm stuck on this number I don't need. All right.
[CUSTOMER][POSITIVE] Sorry, sorry about that.
[AGENT][NEUTRAL] OK, there we go. And then what's the date of service?
[CUSTOMER][NEUTRAL] Um, the first one I have is [PII].
[AGENT][NEUTRAL] OK, and then do we have a bill amount?
[CUSTOMER][NEUTRAL] Uh yes, it's $272.
[AGENT][NEUTRAL] OK, so for this state of service looks like we did get a claim. Uh, the claim was denied. It looks like the outpatient benefit max for the calendar year had already been met.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you need received date, claim number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um, so we didn't get an EOB for that. Um, would you be able to resend the EOB just for our records?
[AGENT][POSITIVE] Yeah absolutely we can fax it. Does that work for you guys?
[CUSTOMER][NEUTRAL] Uh, sure, yeah, I can give you the fax number.
[AGENT][POSITIVE] OK, what's a good thing?
[CUSTOMER][NEUTRAL] Um, it's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. Should I mark that attention to you?
[CUSTOMER][POSITIVE] Uh, yes, if you don't mind, that would be helpful.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so I am sending that it's on its way. Did you need anything else from that data service?
[CUSTOMER][NEUTRAL] Um, not for that data service. I do have a couple more though, we could check.
[AGENT][NEUTRAL] OK, same, yeah, same patient.
[CUSTOMER][POSITIVE] Yes, yes, yep.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the next one?
[CUSTOMER][NEUTRAL] Uh, next one is [PII] for the same bill amount $272.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] Looks like this was the same denial.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you, do you need this one also sent via fax?
[CUSTOMER][NEUTRAL] Uh, yeah, if you don't mind.
[AGENT][POSITIVE] Yeah, not a problem.
[CUSTOMER][POSITIVE] And then I can give you the next one whenever you're ready.
[AGENT][NEUTRAL] Go ahead with the next one.
[CUSTOMER][NEUTRAL] It's uh [PII] for the same bill amount, $272.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] It looks like we did get that claim also. It looks like it's also same denial.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And I can fax this one over to you also.
[CUSTOMER][POSITIVE] OK, thank you. I appreciate it.
[AGENT][NEUTRAL] Yeah, not a problem. Did you need me to check any others, Kendra?
[CUSTOMER][NEUTRAL] Uh, I have 4 more if that's OK with you.
[AGENT][POSITIVE] Yeah, absolutely. Is it the same person?
[CUSTOMER][NEUTRAL] Yes, they're all the same patient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. What's the next day?
[CUSTOMER][NEUTRAL] Next one is [PII], uh, billed amount of $264.
[AGENT][NEUTRAL] 26
[AGENT][NEGATIVE] OK, so it looks like this one was denied also for the outpatient max being already met.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And then I'm ready for the next one whenever you are.
[CUSTOMER][NEUTRAL] Um, it's [PII] for the same bill amount, $264.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Like this is gonna be the same type of denial too, but we did get the claim for 5-16-24.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Sorry, go ahead.
[AGENT][NEUTRAL] No, next one, whenever you're ready.
[CUSTOMER][NEUTRAL] It's uh [PII] for a billed amount of $256.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, looks like we got a claim for this date. It was denied for outpatient benefit max also.
[CUSTOMER][NEUTRAL] OK, and then the last one I have is [PII] for the same bill amount to 56.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, looks like we got this claim also same denial outpatient benefit max.
[CUSTOMER][POSITIVE] OK, perfect. I appreciate your help on all that. Um, if I could just have a reference number please for the call?
[AGENT][NEUTRAL] Absolutely. Call references my name with my last initial than today's date. My name again is [PII], which is [PII] Last initial is [PII].
[CUSTOMER][POSITIVE] Perfect. Thank you for your help.
[AGENT][NEUTRAL] Yeah, not a problem, [PII]. EOBs are coming. I'm sending those, so just give it about 5 minutes for all of them to come through.
[CUSTOMER][POSITIVE] Perfect. Thank you so much.
[AGENT][POSITIVE] You're welcome. Have a good one.
[CUSTOMER][POSITIVE] Thanks you too bye bye.
[AGENT][NEUTRAL] Bye bye.