AccountId: 011433970860
ContactId: 11437b3d-2e67-42e8-965e-235279955a1c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 335429 ms
Total Talk Time (AGENT): 128605 ms
Total Talk Time (CUSTOMER): 73251 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/11437b3d-2e67-42e8-965e-235279955a1c_20250213T18:33_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hi, I'm [PII] calling with the office. I'm looking for a client status today.
[AGENT][NEUTRAL] OK, [PII], you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes, right.
[AGENT][NEUTRAL] Yes, I can help you and [PII], how many claims do you have today?
[CUSTOMER][NEUTRAL] Oh, only one claim?
[AGENT][NEUTRAL] OK. And what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And did you say the area code was [PII]? Is that correct?
[CUSTOMER][POSITIVE] Yes, yes, right.
[AGENT][NEUTRAL] Thank you. And [PII], what is your patient's policy number?
[AGENT][NEUTRAL] Oh, excuse me.
[CUSTOMER][NEUTRAL] I'm sorry, one, just a moment please.
[CUSTOMER][NEUTRAL] OK. The patient policy is 02449815.
[AGENT][POSITIVE] Thank you. One moment, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth, please?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount that you're calling about today, [PII]?
[CUSTOMER][NEUTRAL] OK. The date of service is [PII]. The amount is $495.
[AGENT][POSITIVE] Thank you, one moment please.
[AGENT][NEUTRAL] What is the name of the medical provider facility?
[CUSTOMER][NEUTRAL] Uh, goodnight Medical.
[CUSTOMER][NEUTRAL] It should be
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, so this claim was received, [PII], the received date is [PII].
[AGENT][NEUTRAL] It was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 3554327.
[AGENT][NEUTRAL] And the reason for the denial on this claim?
[AGENT][NEUTRAL] Shows
[AGENT][NEUTRAL] The outpatient benefit for this calendar year has been met.
[CUSTOMER][NEUTRAL] has been met.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, OK. Do you know the benefit amount?
[AGENT][NEUTRAL] The calendar your maximum benefit.
[CUSTOMER][NEUTRAL] Yes, right.
[AGENT][NEUTRAL] Is that what you're asking? One moment. Outpatient, the outpatient benefit maximum per calendar year per covered person for covered outpatient services is $2000.
[CUSTOMER][NEUTRAL] Yes, that's what I'm.
[CUSTOMER][NEUTRAL] OK, $2000. And, and when was the amount met?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Back in [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So there is no more benefits for this patient, right?
[AGENT][NEUTRAL] For that calendar year, that is correct.
[CUSTOMER][NEUTRAL] OK. Um, was it billable to the patient? Can we bill this to the patient?
[AGENT][NEUTRAL] We do not.
[AGENT][NEUTRAL] We do not determine patient responsibility, that would be up to the provider.
[CUSTOMER][POSITIVE] Good, thank you so much uh for the information. Can I have the reference number, please?
[AGENT][POSITIVE] Yes, you will actually use my name that I gave you [PII] along with today's date and if you need a copy of this explanation of benefits, you may print that by going to our portal at [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm, can I have the reference number, please?
[AGENT][NEUTRAL] My name and today's date. my name that I gave you along with today's date. Again, my name is [PII].
[CUSTOMER][NEUTRAL] Can I have your name?
[CUSTOMER][POSITIVE] So you have a great day.
[AGENT][POSITIVE] Thank you. You too, [PII], if that's all I can help you with, and thank you again for calling APL.