AccountId: 011433970860
ContactId: 18582bd3-aa6c-4fda-b389-2b4bad5a1bd9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 768419 ms
Total Talk Time (AGENT): 184586 ms
Total Talk Time (CUSTOMER): 222230 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/18582bd3-aa6c-4fda-b389-2b4bad5a1bd9_20250423T14:45_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi, this is [PII] calling on behalf of office to check on our claim status.
[AGENT][NEUTRAL] OK [PII], I can help you with the claim. Can I please get your callback number just in case the call is disconnected?
[CUSTOMER][NEUTRAL] Sure. Uh, the callback number is going to be [PII]. It's a direct line. Also, may I get your name once again?
[AGENT][NEUTRAL] Yes ma'am, my name is [PII]
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Yes, ma'am. That's correct. And Ms. [PII], what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, one moment. So the member's name was [PII]. One moment. So, yeah. It's uh [PII]. And the member's birthday was [PII]. And the member ID is going to be 02576516.
[AGENT][NEUTRAL] OK, let me look that up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you and then what is um the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Sure. The data service is [PII] and the bill amount comes to $18 even.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] $18 total 18.
[CUSTOMER][NEUTRAL] No, 618.
[AGENT][NEUTRAL] 618. OK, thank you.
[AGENT][NEUTRAL] And what is the name of the provider's office you're calling from?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Doctor [PII] Emergency Medicine.
[AGENT][NEUTRAL] OK I'm gonna put you on a brief hold while I look up this claim for you and I'll be right back.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, [PII]. I have the claim ready for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3576348.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim was denied because the calendar year maximum for outpatient.
[AGENT][NEUTRAL] An emergency room had been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry. Uh, the voice is talking. Could you please spell that once again?
[AGENT][NEUTRAL] Uh, the
[AGENT][NEUTRAL] Yes, the claim was denied because the calendar year maximum has been met.
[CUSTOMER][NEUTRAL] The calendar of Maximum has been met, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh, OK. So, did, um, is the member having any kind of, I mean, uh,
[CUSTOMER][NEUTRAL] A bulk of visits, like, did he make the visit, right?
[AGENT][NEUTRAL] Right, for outpatient.
[CUSTOMER][NEUTRAL] OK, may I have the total number of visits.
[AGENT][NEUTRAL] Yes, met the total.
[CUSTOMER][NEUTRAL] OK, may I know how many wishes the member has totally?
[AGENT][NEUTRAL] Let me look.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] They get 2 visits per calendar year.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] So it was exceeded to this date of service, right?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. OK. May I know when the claim was received?
[AGENT][POSITIVE] Yes ma'am, let me give you that information real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We received the claim on [PII] and processed it on [PII].
[CUSTOMER][NEUTRAL] It is the same as the denial date, right?
[AGENT][NEUTRAL] We were, yes, it was denied on [PII].
[CUSTOMER][NEUTRAL] OK. Mhm. So this visit will be the special responsibility, right? This amount has to be paid by the member.
[AGENT][NEUTRAL] We do not
[AGENT][NEUTRAL] We do not give responsibility.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEGATIVE] We do not give patient responsibility.
[CUSTOMER][NEUTRAL] Are you telling that it's not a patient responsibility?
[AGENT][NEUTRAL] No, I'm saying that our company does not give patient responsibility that's to the provider.
[CUSTOMER][NEUTRAL] OK, then, uh, how this, uh, how, how this bill will be paid?
[CUSTOMER][NEUTRAL] May I know who's going to pay, pay this bill?
[AGENT][NEUTRAL] That is determined by the provider's billing procedures, not by APL we do not give patient responsibility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The, uh, this amount has to be paid by the member, I mean sorry, the provider?
[AGENT][NEGATIVE] No, we do not give patient responsibility.
[CUSTOMER][NEUTRAL] Are
[CUSTOMER][NEUTRAL] OK. I understand. But, uh, what I, what, what my question is, uh, this amount has to be paid by the member, I'm sorry, the provider?
[AGENT][NEUTRAL] That's determined by the provider.
[AGENT][NEGATIVE] We do not give
[AGENT][NEUTRAL] Payment responsibility or patient responsibility.
[AGENT][NEUTRAL] Or provider responsibility.
[CUSTOMER][NEUTRAL] OK then uh.
[CUSTOMER][NEUTRAL] OK, then, then how how the bill will get paid?
[AGENT][NEUTRAL] That is determined by your billing department.
[CUSTOMER][NEUTRAL] One moment. Uh, can you just give me like 2 minutes.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much for your patience. Uh, sorry.
[CUSTOMER][NEUTRAL] Um, can I just fax, uh, can you fax me the copy of EOB?
[AGENT][NEUTRAL] Yes I can do that. What is your fax number?
[CUSTOMER][NEUTRAL] It's gonna be [PII].
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I get that fax ready for you and I'll be right back.
[CUSTOMER][POSITIVE] Yeah, sure. Thank you so much.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, miss. I've got that fax on its way to you now.
[CUSTOMER][POSITIVE] Yeah, thank you so much for that 1 May I know how many days to take to receive the EOP?
[AGENT][NEUTRAL] Oh, it's not gonna take days. It should be there within the next 10 to 15 minutes.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Yeah, thanks so much for your help, uh, sorry, may I get the call reference number?
[AGENT][POSITIVE] Yes, ma'am. You can use my name and today's date and you spell my name, [PII]
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much, [PII]. Thanks for assisting me today and
[CUSTOMER][POSITIVE] Thanks for your patience once again and hope you do really have a great rest of your day, OK?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Thank you, [PII]. That's everything I can help you with today. Is that correct?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Mm, yes. So be no more questions. Uh, thank you so much, sorry.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] You're welcome, Ms. [PII]. Have a good day and thank you for calling APL.
[AGENT][NEUTRAL] Bye bye, ma'am.
[CUSTOMER][POSITIVE] Yeah. Thank you so much. Bye-bye.