AccountId: 011433970860
ContactId: 15d07c4c-6a7f-4782-a9f2-faa1423edef2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 354480 ms
Total Talk Time (AGENT): 145948 ms
Total Talk Time (CUSTOMER): 93149 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/15d07c4c-6a7f-4782-a9f2-faa1423edef2_20250509T16:37_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] from provider's office to check the claim status.
[AGENT][NEUTRAL] OK, [PII], you're needing claim status, is that correct?
[AGENT][NEUTRAL] [PII], did you say that you were needing claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] My callback number is [PII] with no extension.
[AGENT][NEUTRAL] Thank you and how many claims [PII], do you have to check status on today?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Wait, let me check how many claims I have.
[CUSTOMER][NEUTRAL] Uh, 2 claims.
[AGENT][NEUTRAL] OK, are the claims for the same patient or different patients?
[CUSTOMER][NEUTRAL] A and patient.
[AGENT][NEUTRAL] OK, I can help you with both, and [PII], you will use my name that I gave you along with today's date as your call reference number for each one. Also, any information that I provide for you will be a verification of benefits and not a guarantee of payment. And lastly, if we do have the claims on file, [PII], and you need a copy of the explanation of benefits once you have the excuse me, the claim number, you can print those by going to our portal which is located at secured.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Here I have the claim number. If you want direct. OK. I'll start with the policy number or what?
[AGENT][NEUTRAL] All right. And what is your first?
[AGENT][NEUTRAL] Yes, Patient's policy number.
[CUSTOMER][NEUTRAL] 02505608
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Patient
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what is your patient's name, please, and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount please.
[CUSTOMER][NEUTRAL] [PII], bill amount is $4,389.14.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this claim was received. The received date on this claim, [PII], is 1-29-2025.
[AGENT][NEUTRAL] Actually, give me just a moment. It was received on 122, 25.
[AGENT][NEUTRAL] And processed on 123 25.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 355.
[AGENT][NEUTRAL] 4874
[AGENT][NEGATIVE] This claim was denied.
[AGENT][NEUTRAL] And the reason for the denial states benefit maximum for this state of service has been met.
[CUSTOMER][NEUTRAL] Sorry, what did you say? The United States?
[AGENT][NEUTRAL] Maximum, excuse me, Benefit maximum.
[AGENT][NEUTRAL] For this state of service.
[AGENT][NEUTRAL] Has been met.
[CUSTOMER][NEUTRAL] OK. What was the effective date and term date?
[AGENT][NEUTRAL] The effective date on this plan is [PII].
[AGENT][NEUTRAL] And this policy is active.
[CUSTOMER][NEUTRAL] Still after. OK. Uh, then what did mean maximum for this data service has been met, which means?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's what it means. The benefit maximum for this state of service has been met.
[AGENT][NEUTRAL] There was another claim process prior to yours in which the correct the benefit was maxed.
[CUSTOMER][NEUTRAL] OK. It's already in my.
[CUSTOMER][NEUTRAL] OK. OK. OK. Uh, so before that, it has been paid, which means like, uh, so this is not, um, OK.
[AGENT][NEUTRAL] Under another claim under another claim, so your claim was denied for the reason that I've read to you.
[CUSTOMER][NEUTRAL] OK. Got it. Do you have the claim number for that?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Which already paid?
[AGENT][NEUTRAL] Uh, no, ma'am. I can't. Yes, ma'am, but that's for a different provider and I cannot provide you another provider's information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One minute.
[CUSTOMER][POSITIVE] OK, got it. Thank you.
[AGENT][NEUTRAL] You're welcome. And you said that you do have another patient. Is that