AccountId: 011433970860
ContactId: 1bd0405b-d2fc-4318-9591-d16bad63a7a1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 414000 ms
Total Talk Time (AGENT): 145907 ms
Total Talk Time (CUSTOMER): 85089 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/05/1bd0405b-d2fc-4318-9591-d16bad63a7a1_20250605T20:14_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from Proudest office. I'm looking for the claim centers.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status. And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yeah, uh [PII]. It's a direct line.
[CUSTOMER][NEUTRAL] And uh
[AGENT][POSITIVE] Thanks
[CUSTOMER][NEUTRAL] Policy number is 249.
[CUSTOMER][NEUTRAL] 7254.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] and the DUB is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, only one.
[AGENT][NEUTRAL] OK, and may I have the date of service and total bill?
[CUSTOMER][NEUTRAL] Yeah, sure. Uh, date of service is [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] Bill amount is $793 793.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yeah, sure. Uh, the first name is uh May Clinic Fort Smith Community.
[AGENT][POSITIVE] Thank you, and I'm showing we received the claim.
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 359.
[AGENT][NEUTRAL] 9358.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because the calendar year max for diagnostic services has been met.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And can I have the date when it has been met?
[CUSTOMER][NEUTRAL] Hello, are you there?
[AGENT][NEUTRAL] Yes, I'm here. Hold on one moment. I apologize, it was on mute.
[CUSTOMER][NEUTRAL] Yeah, yeah, sorry.
[AGENT][NEUTRAL] Um, let me see if the claim belongs to your provider. If not, I won't be able to give the status. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 352.
[AGENT][NEUTRAL] Um, so it's a.
[AGENT][NEUTRAL] It's a different provider. Um, I can say that the day that the claim was processed that exhausted the the benefit. We usually don't give that information to providers.
[CUSTOMER][NEUTRAL] OK. So, uh, also, may I know how many visits can be allowed for the calendar year?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] How many visits can be allowed for the calendar year?
[AGENT][NEUTRAL] Well, this is for diagnostic testing, so let me, hold on one moment. Let me pull up the full breakdown.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright, so I'm waiting for it to come up now.
[AGENT][NEUTRAL] So for diagnostic testing, the policy will pay up to $250 per calendar year per person.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it was existed, right?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] It was exhausted, right?
[AGENT][NEUTRAL] Yes, by the time your claim came in, the $250 have been applied to another claim.
[CUSTOMER][NEUTRAL] OK, thank you. Um, can you able to send a copy of an EOP through fax?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] Fax number is 585.
[CUSTOMER][NEUTRAL] 440
[CUSTOMER][NEUTRAL] 9493.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][POSITIVE] All right, and I'll go ahead and fax that over to you now. And was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Um, yes, uh, also, can I have the current claim timely spending limit?
[AGENT][NEUTRAL] Um, there's no timely filing limit for a corrected claim.
[CUSTOMER][NEUTRAL] And what about the bill?
[AGENT][NEUTRAL] 180 days from the denial date.
[CUSTOMER][NEUTRAL] And also, can I have your mailing address?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Zip code is, oops, hold on one moment. Zip code is [PII].
[CUSTOMER][NEUTRAL] Is there any fax number?
[AGENT][NEUTRAL] No, there's no fax number for IMA.
[CUSTOMER][NEUTRAL] Thank you. Can I have the reference number, [PII]? Your name is spelled as [PII], right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Thank you. Can I have the reference number?
[AGENT][NEUTRAL] And there's no
[AGENT][NEUTRAL] There's no call reference number, but you can use my name and today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK, thank you, [PII]. Thanks for the day. Thank you for your assistance.
[AGENT][POSITIVE] You're very welcome and thanks for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] Yeah you too bye bye.