AccountId: 011433970860
ContactId: 1fe2a56c-8fb1-49c8-900c-12174e0740ed
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 305100 ms
Total Talk Time (AGENT): 78329 ms
Total Talk Time (CUSTOMER): 168444 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/1fe2a56c-8fb1-49c8-900c-12174e0740ed_20250502T19:38_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, how are you? Um, uh, my name is [PII]. Um, can you please help me to check the denial claim on the patient?
[AGENT][NEUTRAL] Uh yes, [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Uh yes, sure. It's [PII].
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] OK, thank you. Do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Yes, uh, it is 02582661.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, and what was that date of service and bill charges?
[CUSTOMER][NEUTRAL] Uh, the date of service, it is, uh.
[CUSTOMER][NEUTRAL] [PII], the, the charges total is $195.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Uh, it looks like we received the claim for 8-2025, process 4-14-2025 and.
[AGENT][NEUTRAL] Uh, it looks like the maximum for the outpatient sickness rider has been exhausted for the calendar year.
[CUSTOMER][NEGATIVE] So it was denied by the maximum.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Benefit
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So the patient has this insurance because I didn't see any patients uh insurance information under his account. That's why I was wondering, he's eligible. The insurance is active on this patient.
[AGENT][NEUTRAL] Yeah, so they have a benefit, it's a very limited supplemental policy.
[CUSTOMER][NEUTRAL] Yeah,
[AGENT][NEUTRAL] So it just pays 3.
[CUSTOMER][NEUTRAL] Oh, it's the supplement?
[AGENT][NEUTRAL] Yeah, it just pays it just pays 3 visits per year.
[CUSTOMER][NEUTRAL] So how
[CUSTOMER][NEUTRAL] Oh, do we wait for a year?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So it's over already. Let me see, uh, the patient has I in the, maybe he went to see the other doctor instead of our doctor.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, it looks like you saw other providers.
[CUSTOMER][NEUTRAL] So only the lemon.
[CUSTOMER][NEUTRAL] Uh, so our provider is um [PII]. So you have any payment for this doctor?
[CUSTOMER][NEUTRAL] Rupa the call.
[AGENT][NEUTRAL] For this
[AGENT][NEUTRAL] What was the last name?
[CUSTOMER][NEUTRAL] [PII] the call, doctor.
[CUSTOMER][NEUTRAL] The [PII], uh [PII]
[AGENT][NEUTRAL] Uh, no, I don't, I don't show anything. Uh uh.
[CUSTOMER][NEUTRAL] You don't see anything, so maybe the patient went to see the other uh doctors.
[AGENT][NEUTRAL] Yes, they went to other physicians. Yes.
[CUSTOMER][NEUTRAL] And you
[CUSTOMER][NEUTRAL] Oh, went to other position, uh, how much for the limit a year?
[AGENT][NEUTRAL] $75 per and there's a max of 3 visits.
[CUSTOMER][NEUTRAL] You don't have
[CUSTOMER][NEUTRAL] $775 for 3 visits.
[AGENT][NEUTRAL] Yes, per visit.
[CUSTOMER][NEUTRAL] Provisa, OK. So is the
[CUSTOMER][NEUTRAL] OK, 75 it's over. Uh, so this one is the supplement. That's what you said, the supplement plan?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Oh, OK. All right.
[CUSTOMER][NEUTRAL] But do you know the um the primary insurance of the patient?
[AGENT][NEUTRAL] Uh, I don't show any primary insurance on file. You'll have to contact the patient.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Yeah, I don't, I didn't see any other insurance except for this one.
[CUSTOMER][NEUTRAL] And didn't pay so that's why I was wondering is active or not OK so is the supplement plan is active? OK, alright, that's what I need to know um so do I have uh the reference number on this call?
[AGENT][NEUTRAL] A reference number is just my name, [PII], first initial to last name [PII], today's date.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Sorry, I, I didn't get it. 998?
[AGENT][NEUTRAL] My name is [PII], so it's my name, which is [PII], and then today's date, yeah.
[CUSTOMER][POSITIVE] [PII], your name, [PII]. Oh, OK, OK, OK, all right, thank you so much, [PII]. Thank you and have a you have a nice weekend.
[AGENT][NEUTRAL] OK. Thank you for calling ATL.
[AGENT][NEUTRAL] You too.
[CUSTOMER][POSITIVE] Yeah thank you yeah bye bye.