AccountId: 011433970860
ContactId: 1402735b-fbbe-439c-8a6c-637a118337e7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 690010 ms
Total Talk Time (AGENT): 147147 ms
Total Talk Time (CUSTOMER): 135656 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/06/1402735b-fbbe-439c-8a6c-637a118337e7_20250606T14:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII]. Initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Please provide me your initial and last name as well.
[AGENT][NEUTRAL] Um, [PII], last initial [PII]
[CUSTOMER][NEUTRAL] 8.
[CUSTOMER][NEUTRAL] OK. I need your help regarding claim status.
[AGENT][NEUTRAL] I can help you with claim status. Can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] about
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII].
[AGENT][NEUTRAL] OK. And what is the policy number?
[CUSTOMER][NEUTRAL] It's 244-857-2.
[AGENT][NEUTRAL] OK, give me just one moment to look that up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth for me please?
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII] and date of birth is [PII].
[AGENT][POSITIVE] Thank you so much. Give me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] Actually, I do have date of service only.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] You said [PII].
[CUSTOMER][NEUTRAL] No, it's [PII].
[AGENT][NEUTRAL] 0, [PII]? OK.
[CUSTOMER][NEUTRAL] The [PII]
[AGENT][NEUTRAL] And what was the bill amount?
[CUSTOMER][NEUTRAL] It's $460 even, 460.
[AGENT][NEUTRAL] And what is the provider or hospital name?
[CUSTOMER][NEUTRAL] Yeah, uh, facility name is North Shore Hematology oncology Associates, NSHO.
[AGENT][POSITIVE] OK, thank you so much for verifying that with me.
[AGENT][NEUTRAL] It looks like we received this claim on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEGATIVE] It looks like it was denied and let me see the reason why.
[AGENT][NEUTRAL] OK, this claim was denied because the calendar year maximum for the outpatient office visits um has been met for the calendar year.
[CUSTOMER][NEUTRAL] Office visit has been made.
[AGENT][NEUTRAL] So they had met their account they had met their benefit maximum.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And um
[CUSTOMER][NEUTRAL] Could you please send uh
[CUSTOMER][NEUTRAL] Denied UV or our fax.
[AGENT][NEUTRAL] OK give me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Who would you like it um attention to?
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yeah, I'm here.
[AGENT][NEUTRAL] Who would you like the attention to go to?
[CUSTOMER][NEUTRAL] Attention to my name only.
[AGENT][NEUTRAL] Was it [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And could you please confirm fax number?
[AGENT][NEUTRAL] And what is the fax number you would like it sent to?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEGATIVE] Can you start over? It sounds like uh I wasn't able to hear the first part.
[CUSTOMER][NEUTRAL] Yeah. It's [PII].
[AGENT][NEUTRAL] Alright, and just to confirm, I have [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Yeah, absolutely.
[AGENT][NEUTRAL] OK, I just sent that fax over to you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Yeah, I do have one more claim of the same member but different date of service.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the date of service?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what was the amount?
[CUSTOMER][NEUTRAL] It's $460 same as previous one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a moment.
[AGENT][NEUTRAL] OK, it looks like we received this claim on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] And the denial is for the same reason, the calendar year maximum for the outpatient office visits has been met.
[CUSTOMER][NEUTRAL] OK. And uh please tell me claim number.
[AGENT][NEUTRAL] Claim number is 353-9155.
[CUSTOMER][NEUTRAL] OK. [PII], please tell me claim number of previous date of service. Actually, I missed it. So sorry for that.
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][POSITIVE] Mhm. Thank you.
[AGENT][NEUTRAL] 3551601.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Please fax this denied you will be also on the same fax number.
[CUSTOMER][NEUTRAL] With some attention.
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright I just sent that over.
[CUSTOMER][NEUTRAL] Yeah. OK. And uh please provide me a reference number for our conversation.
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] Call reference number
[AGENT][NEUTRAL] OK, we don't have call reference numbers. You can use my name and today's date, so [PII] and today's date.
[CUSTOMER][POSITIVE] OK, not an issue. [PII], thanks for your assistance and hope you have a good day ahead.
[AGENT][POSITIVE] Great, thank you so much for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Yeah. Bye-bye. Happy weekend.
[AGENT][NEUTRAL] Bye.