AccountId: 011433970860
ContactId: 1d770968-5a97-42d7-8bd2-7db3ccb6aa9e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 264640 ms
Total Talk Time (AGENT): 87630 ms
Total Talk Time (CUSTOMER): 89099 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/1d770968-5a97-42d7-8bd2-7db3ccb6aa9e_20250210T19:55_UTC.wav
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[AGENT][POSITIVE] Good Afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] with initial T as in Tango calling from the provider's office regarding claim denial status.
[AGENT][NEUTRAL] OK, I can verify claim status for you and I'm sorry, you say your name is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] 945137.
[AGENT][NEUTRAL] OK, and do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, [PII]. It's a direct line.
[AGENT][NEUTRAL] OK. And verify the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Yes. Patient's name is uh
[CUSTOMER][NEUTRAL] [PII], [PII] is the date of birth.
[AGENT][NEUTRAL] OK, and what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] Data services [PII].
[CUSTOMER][NEUTRAL] And the bill amount is?
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let me add it up. Uh, it's in pages.
[CUSTOMER][NEUTRAL] $742.50.
[AGENT][NEUTRAL] And the patient, uh, the balance after primary process the claim?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Only actually.
[CUSTOMER][NEUTRAL] Only uh APL for this one. There is no other uh insurance.
[AGENT][NEUTRAL] Uh, they have to. This is a secondary supplemental policy only, so they have to have other insurance.
[CUSTOMER][NEUTRAL] On my end.
[CUSTOMER][NEUTRAL] Understood.
[AGENT][NEUTRAL] 21 and you're calling from?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Uh, Duke University affiliated physicians.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Duke Primary care.
[AGENT][NEUTRAL] Um, I'm trying to a claim process to counter your max for doctor's visits has been met.
[CUSTOMER][NEUTRAL] So it is not processed because uh maximum benefits reached uh.
[AGENT][NEUTRAL] It has been processed as the max benefit has been met for the calendar year.
[CUSTOMER][NEUTRAL] Is that it?
[CUSTOMER][NEUTRAL] OK, Max and I dash one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][POSITIVE] Maximum benefit.
[CUSTOMER][POSITIVE] Has been exceeded.
[CUSTOMER][NEUTRAL] For the calendar year.
[CUSTOMER][NEUTRAL] And this is as per the patient's plan.
[AGENT][NEUTRAL] Yes, for the patient's policy.
[CUSTOMER][NEUTRAL] Visions.
[CUSTOMER][NEUTRAL] Uh, is there anything we can do for this to be for the process or that is all?
[AGENT][NEUTRAL] That is all. I mean, let me see when it was processed, I would say you can submit an appeal. But for the patient's policy, they only allowed so many visits per year and they've already met that, so.
[AGENT][NEUTRAL] Uh, showing this claim was processed [PII], so you have up to 180 days from, no, I'm sorry, you passed [PII], so it's past time for the claim to for an appeal.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got it, thank you so much for that information.
[CUSTOMER][NEUTRAL] Call reference number for this one, please.
[AGENT][NEUTRAL] Uh, we don't give reference numbers. You may use my name in today's date.
[CUSTOMER][NEUTRAL] OK, uh, one moment, let me check one more thing if I if I have some more claims on this.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] That is all. Thank you. Thank you so much for your help today and have a nice day moving forward.
[AGENT][NEUTRAL] You're welcome, [PII]. Thanks for calling [PII] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] OK.