AccountId: 011433970860
ContactId: 075403bd-6b6b-49b6-945c-8fb91768eec4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 813830 ms
Total Talk Time (AGENT): 199110 ms
Total Talk Time (CUSTOMER): 160872 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/075403bd-6b6b-49b6-945c-8fb91768eec4_20250528T18:35_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes, hi [PII]. My first name is [PII]. My last name is [PII] calling you from the provider's office looking for claim status.
[AGENT][NEUTRAL] I can help you with claim status, [PII]. Can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Uh, yes, the call back number [PII].
[AGENT][POSITIVE] Thank you so much. And do you have the policy number with you?
[CUSTOMER][NEUTRAL] Uh yes, the patient's ID is 02179837.
[AGENT][NEUTRAL] Give me just a second while I look that up for you.
[AGENT][NEUTRAL] Can I get you to verify the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Uh, the first name is [PII], last name is [PII], and the date of birth is uh.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] And do you have the claim number or the date of service?
[CUSTOMER][NEUTRAL] Data service uh July [PII]. Total charge is $5,134 even.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me check.
[AGENT][NEUTRAL] Sorry, give me just a moment.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Oh, I just lost it. I'm so sorry.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like we received that claim on [PII].
[AGENT][NEUTRAL] It was processed on the same day, [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Claim number is 3563479.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And that claim was denied.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Due to the outpatient benefits for that calendar year had been met.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Uh, how many times can we build in a month or in a year?
[AGENT][NEUTRAL] Um, it would go based off of his maximum.
[CUSTOMER][NEUTRAL] Or Be Med, is it?
[CUSTOMER][NEUTRAL] In dollar.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Are you wanting to know what his um maximum was?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like his outpatient.
[AGENT][POSITIVE] Benefit maximum.
[AGENT][NEUTRAL] For the year [PII].
[AGENT][NEUTRAL] It was $2500 and that is an explanation of benefits and not a guarantee of payment. And so it looks like he had already met his maximum of the $2500 before this um claim.
[CUSTOMER][NEUTRAL] OK, and the up your family funding limit.
[AGENT][NEGATIVE] We don't have timely filing.
[CUSTOMER][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] And the new address.
[AGENT][NEUTRAL] For an appeals?
[AGENT][NEUTRAL] It will be [PII].
[CUSTOMER][NEUTRAL] Uh-huh, yes.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] In [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII] and you'll do attention appeals.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh, uh, [PII], right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] OK thank you let's move to the next patient.
[AGENT][NEUTRAL] No, give me just one moment.
[AGENT][NEUTRAL] And do you have another claim for a different patient?
[CUSTOMER][NEUTRAL] Uh yes.
[AGENT][NEUTRAL] OK, give me just a moment. Let me close out the notes for this patient and I'll be with you in just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it's for a different patient, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. What's the policy number?
[CUSTOMER][NEUTRAL] Uh, the policy ID is 02131572.
[AGENT][NEUTRAL] One moment while I look that up for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh yes, the patient, the first name is [PII] Last name is uh [PII]
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] And do you have the date of service?
[CUSTOMER][NEUTRAL] The service is [PII] and the total charge is uh just $6,267 even.
[AGENT][NEUTRAL] OK, give me just a moment while I look that up.
[AGENT][NEUTRAL] I'm not showing a claim for that date of service for that amount. You said [PII]?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, uh, what is the time, and you said that there is no time in following, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Can I have the memory effective this?
[AGENT][NEUTRAL] OK, this policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Uh, thank you, let's move to the next patient.
[AGENT][NEUTRAL] OK. Give me just a moment so that I can um
[AGENT][NEUTRAL] Finish up the notes on this one, then we can move on to the next.
[AGENT][NEUTRAL] And what is the next policy number?
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] OK. And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Date of birth is uh [PII] and the first name is [PII] and the last name is [PII].
[AGENT][NEUTRAL] I'm not showing anyone with that name under this policy, 60801.
[CUSTOMER][NEUTRAL] Let me just recheck it.
[CUSTOMER][NEUTRAL] 60801, yes.
[CUSTOMER][NEUTRAL] And just to make sure the patients.
[CUSTOMER][NEUTRAL] The first name is [PII] the last name is [PII].
[AGENT][NEUTRAL] First name was [PII].
[CUSTOMER][NEUTRAL] Um, yes.
[AGENT][NEUTRAL] OK. I can look it up by his name.
[CUSTOMER][NEUTRAL] OK, just so.
[AGENT][NEUTRAL] Um, because that's not who we have for that policy number.
[CUSTOMER][NEUTRAL] So, uh, with the patient's ID which I provided you, you cannot be able to pull the patients, right?
[AGENT][NEUTRAL] Right, I can look him up by his last name.
[CUSTOMER][NEUTRAL] OK. uh, thank you. Uh, do you have any call reference number?
[AGENT][NEUTRAL] Um, we don't have call reference numbers. You can use my name and last initial in today's date.
[AGENT][NEUTRAL] So [PII], and today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh, OK, thank you so much. That's all I need for today and have a very blessed day.
[AGENT][POSITIVE] Thank you for calling APL and have a great day.
[CUSTOMER][POSITIVE] Mhm. Thank you, bye.
[AGENT][NEUTRAL] Bye.