AccountId: 011433970860
ContactId: 1ac2b0ca-19c2-4cf6-82ae-f3567df4f3e7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 876700 ms
Total Talk Time (AGENT): 219891 ms
Total Talk Time (CUSTOMER): 178019 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/1ac2b0ca-19c2-4cf6-82ae-f3567df4f3e7_20250117T21:44_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, yes, hi, my first name is uh [PII], my last name is [PII] calling you from the provider's office looking for claim status.
[AGENT][NEUTRAL] Yeah, sure. I can assist you with claim status. And may I have a callback number just in case we get disconnected, Mr. [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 2,331,800.
[AGENT][NEUTRAL] OK. What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Uh [PII] Last name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Perfect, thank you. And uh may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] 728 2023 total charges.
[CUSTOMER][NEUTRAL] Uh, $4,526 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] You said 7:28 of 23?
[CUSTOMER][NEUTRAL] Mhm, yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Um, let me have that policy number one more time.
[CUSTOMER][NEUTRAL] Uh, the patient side is.
[CUSTOMER][NEUTRAL] 2,331,800.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Is this for your facility charges?
[CUSTOMER][NEUTRAL] Uh yes.
[AGENT][NEUTRAL] Yeah, it doesn't look like we have received the facility bill yet.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Sorry saying that uh you don't have a claim on file.
[AGENT][NEUTRAL] No, I don't see that claim on file.
[CUSTOMER][NEUTRAL] Can I have team members effective date?
[AGENT][NEUTRAL] Sure. Effective date on this policy is [PII] and it terminated [PII].
[CUSTOMER][NEGATIVE] And there is no time in filing, right?
[AGENT][NEUTRAL] Correct, there's no family filing limit.
[CUSTOMER][NEUTRAL] OK, let's move to the next ID.
[AGENT][NEUTRAL] Bear with me, I'll have to make a note before we move forward, and this is gonna be the a different policy, correct?
[CUSTOMER][NEUTRAL] Mhm yes.
[AGENT][NEUTRAL] OK, so you don't need any other information on this one.
[CUSTOMER][NEGATIVE] Uh, no.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, go ahead with the next policy number.
[CUSTOMER][NEUTRAL] 023 07621.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII]. 1st name is uh [PII], last name is [PII].
[AGENT][NEUTRAL] OK, what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII] total charge is $3,938.75.
[AGENT][POSITIVE] OK, thank you. Let me see if I can find this one.
[AGENT][NEUTRAL] OK, I don't see a claim for [PII].
[CUSTOMER][NEUTRAL] OK, can I have the member's effective date?
[AGENT][NEUTRAL] OK. So this one was effective on [PII] and it terminated [PII].
[CUSTOMER][NEUTRAL] OK, let's move to the next item.
[AGENT][NEUTRAL] Yeah, I had to make a note and you don't need any other information on this one.
[CUSTOMER][NEUTRAL] Mhm, yes.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, what is the next policy number?
[CUSTOMER][NEUTRAL] 248-9250.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII]. 1st name is [PII] Last name is [PII].
[AGENT][NEUTRAL] OK, and what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Uh, [PII] total charge is $2,162 even.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, let me pull the EOB for this 11 moment.
[AGENT][NEUTRAL] I'm waiting on the EOB. Bear with me.
[AGENT][NEUTRAL] OK, so this one was processed on [PII].
[AGENT][NEUTRAL] And the claim was denied. Um, the reason for this denial is that
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The maximum benefit for the date of service has been met.
[CUSTOMER][NEUTRAL] OK, uh, what is the address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] City, [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] And the
[CUSTOMER][NEUTRAL] Uh, up to timely farming limit.
[AGENT][NEUTRAL] 180 days from the decision date.
[CUSTOMER][POSITIVE] Thank you, let's move to the next patient.
[AGENT][NEUTRAL] OK, bear with me.
[CUSTOMER][NEUTRAL] Just said 2 more.
[AGENT][NEUTRAL] OK, bear with me. Let me make a note on this one.
[AGENT][NEUTRAL] It's gonna be one more minute.
[AGENT][NEUTRAL] OK, what's the next policy number?
[CUSTOMER][NEUTRAL] 021-73249.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII]. 1st name is uh [PII], last name is [PII].
[AGENT][NEUTRAL] OK, what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Uh, [PII] and the total charge is.
[CUSTOMER][NEUTRAL] Uh, $7,386 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And that was [PII].
[CUSTOMER][NEUTRAL] No, uh, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me go back.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You don't have that claim on file?
[CUSTOMER][NEUTRAL] OK, can I have the member expected date?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That is [PII] and it's still active.
[CUSTOMER][POSITIVE] Thank you. Let's go to the last question.
[AGENT][NEUTRAL] OK, bear with me, let me make a note.
[AGENT][NEUTRAL] It was the last policy.
[CUSTOMER][NEUTRAL] 02399312.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII]. 1st name is [PII] and last name is [PII].
[AGENT][NEUTRAL] Alright, what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Uh, [PII] total charge is $3,702 even.
[AGENT][NEUTRAL] You said $3,742 even?
[CUSTOMER][NEUTRAL] 3000
[CUSTOMER][NEUTRAL] $702 even.
[AGENT][POSITIVE] Oh. Thank you.
[AGENT][NEUTRAL] And the date of service was [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] That claim is not on file.
[CUSTOMER][NEUTRAL] OK, members effective date.
[AGENT][NEUTRAL] That is um [PII] and it is active at the moment.
[CUSTOMER][NEUTRAL] OK, uh, do you have any call reference number?
[AGENT][NEUTRAL] We don't have reference numbers, Mr. [PII]. You can use my name in today's date.
[CUSTOMER][POSITIVE] OK, uh, thank you so much, that's all I need for today have a very blessed day ahead.
[AGENT][POSITIVE] You as well thank you for calling APL. Have a good day, Mr. [PII].
[CUSTOMER][POSITIVE] Thank you, bye.
[AGENT][POSITIVE] You're welcome. Bye bye.