AccountId: 011433970860
ContactId: 0e4fbc84-539a-4e99-9081-8f3f72a2e4cd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 499769 ms
Total Talk Time (AGENT): 160366 ms
Total Talk Time (CUSTOMER): 224211 ms
Interruptions: 14
Overall Sentiment: AGENT=1.4, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/0e4fbc84-539a-4e99-9081-8f3f72a2e4cd_20250523T13:10_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] calling from products billing office checking for claim status.
[AGENT][NEUTRAL] I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, and [PII], you have a claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number please, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] Yes, the callback number I have here [PII] is a direct line.
[AGENT][NEUTRAL] Thank you and your uh you, do you have only one claim to check status on?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what is that member's policy number? I can help you with this.
[CUSTOMER][NEUTRAL] That member's policy number? I can help you with that. Yes, 02498570.
[AGENT][POSITIVE] Thank you, one moment please.
[CUSTOMER][NEUTRAL] D for [PII].
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Any information [PII] that I do provide for you today will be a verification of benefits and not a guarantee of payment. Again, what is your patient's name and also their date of birth?
[CUSTOMER][NEUTRAL] Information from that I do for you today will be a patient of benefits and not a guarantee of payment. Again, what is your patient's name and also their date of birth? S for [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] What is the
[CUSTOMER][NEUTRAL] Yes, [PII]. And it got billed for $279 and even $279.
[AGENT][NEUTRAL] $279 even, is that correct?
[CUSTOMER][NEUTRAL] $279 even, is that correct? Yes.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do see that this claim was received. It was received on [PII], processed on [PII].
[CUSTOMER][NEUTRAL] So I do see that this claim was received. It was received on [PII], processed on [PII].
[AGENT][NEUTRAL] The claim number is 35760667.
[CUSTOMER][NEUTRAL] The claim number is 357.
[CUSTOMER][NEUTRAL] 606-7.
[AGENT][NEUTRAL] This claim was denied, [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] This claim was deni data. Mhm.
[AGENT][NEUTRAL] And the reason for the denial states the maximum outpatient benefit payable for this occurrence has been met.
[CUSTOMER][NEUTRAL] And the reason for the denial state the maximum outpatient benefit payable for this occurrence has been met.
[AGENT][NEUTRAL] He occurrence means treatment for the same or related condition unless separated by a period of 90 days. Treatment for
[CUSTOMER][NEUTRAL] Our current means treatment for the same or related confection unless separated by a period of 90 days. Treatment for.
[AGENT][NEUTRAL] Treatment for the same or related conditions separated by 90 days or unrelated conditions will be considered a new per occurrence.
[CUSTOMER][NEUTRAL] Treatment for the same or related condition separated by 90 days or separated condition will be considered a new occurrence.
[AGENT][NEGATIVE] And all of a sudden, Tom, there is something that's causing the, everything I say is echoing back on me.
[CUSTOMER][NEUTRAL] And all of a sudden, Tom, there is something that's causing everything I say echoing back on.
[CUSTOMER][NEUTRAL] Sure. And uh may I have the amount, what is allowed for a maximum calendar year or 90 days? Is that $1000?
[AGENT][POSITIVE] That's better.
[AGENT][NEUTRAL] OK, this is
[AGENT][NEUTRAL] OK, this is not a per calendar year. This is a per occurrence benefit.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] This is not a calendar year. This is like for a current benefit.
[AGENT][NEUTRAL] And the per occurrence benefit maximum on this policy is $1000 per occurrence.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the per current benefit maximum on this policy is $10,000 per occurrence.
[CUSTOMER][NEUTRAL] Mhm. And um could you help me the date when was last maximum met?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Sure. Thanks for that. And uh I just have a clarification like uh uh we have received two EOBs from APL um.
[CUSTOMER][NEUTRAL] The claim number you have given me 3576067. Uh, the UB said like non-covered and another UB 3 yeah, another UB 35.
[AGENT][NEUTRAL] And what
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 682-2 and not denied maximum benefit exhausted. And um is that the same thing or uh I just need an updated EOB on this for 357607 as a maximum exhaustion.
[AGENT][NEUTRAL] OK, the claim number that I gave you is the claim number that that goes along with this number and this data service and that bill amount.
[CUSTOMER][NEUTRAL] OK, the claim number that I gave you the claim number just to make it goes along with this number and this data service in that building. Sure. And uh price is that possible to fax me an EOB for this?
[AGENT][NEUTRAL] You can actually print it yourself, [PII], by going to our portal at [PII] now that you have the correct claim number.
[CUSTOMER][NEUTRAL] You can actually print it yourself by going to our portal. Mhm.
[CUSTOMER][NEUTRAL] So [PII] now that you have.
[CUSTOMER][NEUTRAL] The correct claim number.
[CUSTOMER][NEUTRAL] Check your [PII].
[AGENT][POSITIVE] It's secured S [PII]
[CUSTOMER][NEUTRAL] The keywords.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, I'll get it. I'll get that and could you help me with call reference, please?
[AGENT][POSITIVE] Absolutely, you would use my name along with today's date.
[CUSTOMER][NEUTRAL] Oh, you would reduce my name on with today's day.
[CUSTOMER][POSITIVE] Thank you, [PII], and thanks for assisting. Take care. That's all for the day.
[AGENT][POSITIVE] Oh, well, you're very welcome. Yes, sir. Well, thank you again for calling APL today, [PII] and I hope you have a wonderful weekend.
[CUSTOMER][POSITIVE] You're very welcome. Yes, sir. Well, thank you again for calling into [PII] and I hope you have a wonderful weekend. Yeah, take care. Bye now.
[AGENT][POSITIVE] Uh, you're welcome. Thank you. Bye bye.
[CUSTOMER][POSITIVE] You're welcome. Thank you, bye bye. Bye.