AccountId: 011433970860
ContactId: 19a6aa60-70ef-4696-b0ae-d1c1b4a2a9f1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 712320 ms
Total Talk Time (AGENT): 240049 ms
Total Talk Time (CUSTOMER): 164916 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/19a6aa60-70ef-4696-b0ae-d1c1b4a2a9f1_20250225T21:01_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] Hi, this is [PII]. I'm calling you from the provider's office to check claim status for this number.
[AGENT][NEUTRAL] OK, you have one patient to check claim status for, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And I'm sorry, what was your first name again?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] I'm sorry, I still didn't understand you.
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] OK, thank you and what is your callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And it's a direct flight.
[AGENT][NEUTRAL] Thank you and what is your patient's policy number please [PII]?
[CUSTOMER][NEUTRAL] It's 1407207, M as in M, L as in lion, 8.
[AGENT][NEUTRAL] OK, if you'll repeat that again please.
[CUSTOMER][NEUTRAL] Yeah, sure. It's 1407207 ML8.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] I'm back any information that I do provide today would be a verification of benefits and not a guarantee of payment. What is your patient's name please and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and the middle name is [PII] and the last name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. What is the date of service and total bill amount?
[CUSTOMER][NEUTRAL] The date of service is uh [PII] and the total bill amount is
[AGENT][NEUTRAL] I'm sorry, I didn't understand you. What is, yes ma'am, again back, what is the data service?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] 817-2023, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and the total bill amount?
[CUSTOMER][NEUTRAL] And the
[CUSTOMER][NEUTRAL] It's $1,124 even.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] OK just one moment there.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this claim was received back. The received date on this claim was 11-22-2024. It was processed and denied on the same date.
[AGENT][NEUTRAL] The claim number is 3533.
[CUSTOMER][POSITIVE] Oh sorry. Sorry to, sorry to interrupt you. Um,
[AGENT][NEUTRAL] [PII], are you still there?
[CUSTOMER][NEUTRAL] Yes, I am there. Uh, last time it was on [PII]. The claim was sent for the tracker.
[AGENT][NEUTRAL] For what? It was set for, I'm sorry?
[CUSTOMER][NEUTRAL] It was saying for the uh chick cracker.
[AGENT][NEUTRAL] For the what?
[CUSTOMER][NEUTRAL] Uh, can you please check with this call reference number?
[AGENT][NEUTRAL] No ma'am, I can check with the claim number.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] What is the claim number?
[AGENT][NEUTRAL] I have the claim in front of me. This claim was reviewed. It was received and reviewed on [PII].
[CUSTOMER][NEUTRAL] Yeah, the claim number.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] The claim number is 353-358-4.
[AGENT][NEUTRAL] This kind
[CUSTOMER][NEUTRAL] Uh, is it, uh, process towards the uh detectable?
[AGENT][NEGATIVE] It was denied.
[AGENT][NEUTRAL] And the reason for the denial states outpatient benefit for this calendar year has been met.
[CUSTOMER][NEUTRAL] So when did you receive the claim?
[AGENT][NEUTRAL] The claim was received and processed on the same day, 11-22-2024.
[AGENT][NEGATIVE] And it was denied
[CUSTOMER][NEUTRAL] You know on.
[AGENT][NEUTRAL] With the remark that I read to you. [PII].
[CUSTOMER][NEGATIVE] It was processed, uh, processed on and denied on the same day.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And by, by Thursday night.
[AGENT][NEUTRAL] Outpatient benefit?
[AGENT][NEUTRAL] For this calendar year has been met.
[CUSTOMER][NEUTRAL] it's.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you need a copy of this explanation of benefits back, you may print that by going to our portal and our portal website is secured. [PII].
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] And is there any other information that I can help you with?
[CUSTOMER][NEUTRAL] Uh, this.
[CUSTOMER][NEUTRAL] This patient uh made the total uh visits or the total units.
[AGENT][NEUTRAL] The calendar year max on this benefit had been met and on this policy at the time, the outpatient calendar year benefit max, give me one moment.
[AGENT][NEUTRAL] Was $1500.
[CUSTOMER][NEUTRAL] And what is the claim number?
[AGENT][NEUTRAL] Do you need for me to repeat that again?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] 353-358-4
[CUSTOMER][NEUTRAL] It's 353-584, is that right?
[AGENT][NEUTRAL] 353-3584.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So what we can do for this number, can we upgrade uh for this number?
[AGENT][NEUTRAL] I'm sorry, you can, you have 180 days to file an appeal in writing from the date of the decision.
[AGENT][NEUTRAL] And it would need to be mailed to our claims mailing address attention appeals department.
[CUSTOMER][NEUTRAL] Uh, uh, the time defining limit is 180 days from the denial date.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, can you please provide me the patient effective date and termination.
[AGENT][NEUTRAL] Effective date [PII], term date [PII].
[CUSTOMER][NEUTRAL] Sorry, can you please repeat the termination date again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And can you please provide me the meeting with this?
[AGENT][NEUTRAL] I did not ask, uh, what was your question [PII]?
[CUSTOMER][NEUTRAL] Mailing address.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] attention appeals department.
[CUSTOMER][NEUTRAL] At last, it's [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] And is there anything else I can help you with?
[CUSTOMER][NEUTRAL] And can you please provide me the fax number too?
[AGENT][NEUTRAL] [PII] but you cannot fax an appeal. You must mail it to that PO box that I gave you.
[CUSTOMER][NEUTRAL] OK. Can you please provide me the call reference number?
[AGENT][NEUTRAL] My name is that I gave you along with today's date.
[CUSTOMER][NEUTRAL] Can you please spell your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Sorry, can you please spell it again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you for your assistance. Have a wonderful day.
[AGENT][NEUTRAL] Kind of
[AGENT][POSITIVE] You're welcome. Yes, ma'am. You too. Thank you again for calling APL and I hope you have a nice rest of your day as well.
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][POSITIVE] Mhm thank you bye bye.