AccountId: 011433970860
ContactId: 0cb4613a-d340-4828-b1d4-ef46148266d2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 514979 ms
Total Talk Time (AGENT): 121437 ms
Total Talk Time (CUSTOMER): 251192 ms
Interruptions: 3
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/0cb4613a-d340-4828-b1d4-ef46148266d2_20250415T14:27_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] calling from Anderson Medical Group to check on a claim status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status today. Do you have that policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, that would be 01902342.
[AGENT][POSITIVE] Perfect. Thank you.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And then what's a good call back number in case our call gets dropped?
[CUSTOMER][NEUTRAL] That would be [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Perfect, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. And then patient's first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] Patient name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] What do you
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And then do you have that data service and charge amount or a claim number?
[CUSTOMER][NEUTRAL] Yeah, I do have a date of service which is [PII] with the charge amount $128.60.
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] Perfect. And you said [PII]?
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Welcome.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so it looks like the received date for this claim was [PII].
[AGENT][NEUTRAL] The process date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it looks like.
[AGENT][NEGATIVE] This claim was denied.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] So this claim was denied because this is not a covered loss under the plan. Therefore, no amount is payable for this expense.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] OK, got it. Thank you so much. Can I have the uh claim number?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am. It's 357.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] 2037.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it. Uh, so you're stating that the claim was denied for non-covered under patient plan, is that right?
[AGENT][NEUTRAL] Yes, ma'am. Yes.
[CUSTOMER][NEUTRAL] OK. So that is the case, uh, shall we build the patient?
[AGENT][NEUTRAL] Sorry, what was that?
[CUSTOMER][NEUTRAL] Uh, so it is for, uh, the patient plan, it is not covered. I'm asking whether we can bill the patient.
[AGENT][NEGATIVE] Yes, it is not covered under this plan.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][POSITIVE] Thank you so much. Uh, instead, I'm, I'm asking whether we can bill the charges to the patient.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Uh, we don't, we do not determine the patient's responsibility.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, got it. Thank you so much. Is there any specific reason why it is not covered under the patient plan?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me check for you, just a moment.
[CUSTOMER][POSITIVE] Sure, no problem. Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah you're gonna go.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEGATIVE] So it looks like the amount has been maxed out for the outpatient amount per calendar year is why it was denied.
[CUSTOMER][NEUTRAL] I'm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Got it. Thank you so much. And may I know uh the maximum amount covered for the patient for the year?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Just one moment.
[CUSTOMER][NEUTRAL] Maybe you
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] So it looks like under the patient's policy, the outpatient benefit max is 1000 per covered person per calendar year.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] For the outpatient services which they have already met, so that's why we are not covering this claim.
[CUSTOMER][POSITIVE] OK, thank you so much for evaluating all this information. I really appreciated that. Can I have the call reference number?
[AGENT][NEUTRAL] Yes, it's my first name, [PII], which is [PII]
[AGENT][NEUTRAL] And last initial.
[CUSTOMER][POSITIVE] Perfect. Thank you so much.
[AGENT][NEUTRAL] Sorry, last initial [PII], and then it it would be today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect. Thank you so much. Have a great day, [PII]. Bye bye.
[AGENT][POSITIVE] Yes, thank you for calling APL. Have a good day.
[AGENT][NEUTRAL] Mhm.