AccountId: 011433970860
ContactId: 1db82aa9-bef6-4a99-93a3-2338ca08b385
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 448899 ms
Total Talk Time (AGENT): 157594 ms
Total Talk Time (CUSTOMER): 110047 ms
Interruptions: 3
Overall Sentiment: AGENT=0.9, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/1db82aa9-bef6-4a99-93a3-2338ca08b385_20250527T15:27_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Good morning thank you for calling AT.
[CUSTOMER][NEUTRAL] Hi, this is [PII] from provider's office for the claim details.
[AGENT][NEUTRAL] OK, [PII], you have one claim that you're needing the status on, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] It's [PII] is a direct line?
[AGENT][NEUTRAL] Thank you and the member's policy number, please?
[CUSTOMER][NEUTRAL] Sure. The policy number is 02199611 M as in Mary L as in Lima 8.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] One moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] I'm sorry, but there is something in your background, [PII], that's very loud that's making it difficult for me to hear you.
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] Is it better now?
[AGENT][POSITIVE] It is better at the moment.
[CUSTOMER][POSITIVE] OK I'm so sorry for that.
[AGENT][NEUTRAL] And any information provided.
[CUSTOMER][NEUTRAL] Uh, I missed your name. Can you repeat your name, please?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] You're welcome, and any information provided will be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's first name is [PII], last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you and the date of service and total bill amount?
[CUSTOMER][NEUTRAL] [PII] total allowed amount is $2,288 even.
[AGENT][NEUTRAL] 2288, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, just please bear with me. My system is moving incredibly slowly, so just a moment.
[CUSTOMER][POSITIVE] Sure, take your time.
[AGENT][NEUTRAL] OK, so this claim was received on [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the claim was processed.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] The claim number is 3579987.
[CUSTOMER][NEUTRAL] 357.
[AGENT][POSITIVE] And there was a benefit.
[CUSTOMER][NEUTRAL] Can you repeat that claim number?
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] 357-99887.
[CUSTOMER][NEUTRAL] 3
[AGENT][NEUTRAL] And there was a benefit paid in the amount of $103.88.
[CUSTOMER][NEUTRAL] 88.
[AGENT][NEUTRAL] And that was paid on single check, 203-4748.
[CUSTOMER][NEUTRAL] 3.
[CUSTOMER][NEUTRAL] 748
[CUSTOMER][NEUTRAL] OK, and is there any patient responsibility?
[AGENT][NEUTRAL] We do not determine patient responsibility that would be up to the provider to determine that.
[AGENT][NEUTRAL] And [PII], if you need a copy of this explanation of benefits, you may print that from our portal by going to [PII].
[CUSTOMER][NEUTRAL] But we have received a partial denial as well on this stating the benefit max for the time period. Is, can you just check that?
[AGENT][NEUTRAL] Yes ma'am, on this claim, right, I gave you the benefit amount paid and it states with this check, the maximum benefit payable for this date of service has been met.
[CUSTOMER][NEUTRAL] How much was uh maximum benefit allowed for this?
[AGENT][NEUTRAL] The maximum excuse me, the maximum outpatient benefit per calendar day for covered outpatient services is $200.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. Uh, for this date of service, correct?
[AGENT][NEUTRAL] Yes, ma'am. There was another claim that was also received and processed prior to your claim being received.
[CUSTOMER][NEUTRAL] But we
[AGENT][NEUTRAL] So for your claim, the benefit of $103.88 was the maximum benefit payable.
[CUSTOMER][NEUTRAL] OK, no worries. Uh, just help me with the reference number for the call, please.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] My name along with today's date.
[CUSTOMER][NEUTRAL] Last name initial?
[AGENT][NEUTRAL] S
[CUSTOMER][NEUTRAL] Ah, and this maximum benefit was allowed per, uh, unit or it was like for the, uh.
[AGENT][NEUTRAL] I explained that that's a maximum benefit amount per calendar day for covered outpatient services.
[CUSTOMER][POSITIVE] OK. No worries. So, thank you. Thank you for your time and assistance.
[AGENT][POSITIVE] You're welcome. I said [PII], again, if that is all I can help you with. Thank you for calling APL and I hope you have a nice day.
[CUSTOMER][POSITIVE] Thank you bye.