AccountId: 011433970860
ContactId: 21b329b0-39a1-410d-a349-8bd8e384267b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 264369 ms
Total Talk Time (AGENT): 111896 ms
Total Talk Time (CUSTOMER): 62644 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/21b329b0-39a1-410d-a349-8bd8e384267b_20250210T14:58_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hey, my name is [PII] calling from the provider office and um I am here for the claims.
[AGENT][NEUTRAL] OK, did you say that your name is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And you're needing claim status, [PII], is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number and first off, [PII], how many claims do you have to check status on?
[CUSTOMER][NEUTRAL] Uh, only one.
[AGENT][NEUTRAL] OK, and what is that member's policy number, please?
[CUSTOMER][NEUTRAL] It's um 02548554.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth, please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Patient's name is uh [PII], and date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her place?
[CUSTOMER][NEUTRAL] It's um [PII].
[CUSTOMER][NEUTRAL] And total bill amount is $10,450.
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] OK, so I do show that this claim was received. The received date was [PII]. It was processed and denied on [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] The claim number is 353-6016.
[AGENT][NEUTRAL] And the reason for the denial states outpatient benefit for this calendar year has been met.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Can you tell me the date when the outpatient benefit has been met?
[AGENT][NEUTRAL] [PII] a claim that was processed.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] I can't provide you any details on that claim, [PII] because that was not for this provider.
[CUSTOMER][POSITIVE] Mhm. Got it. Thank you so much.
[AGENT][NEUTRAL] You're welcome. And if you need a copy of this explanation of benefits, [PII], you may go to our portal.
[CUSTOMER][NEUTRAL] And uh yeah.
[AGENT][NEUTRAL] Which is located at [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Got it. Thank you so much. And uh yeah, uh that's it for the last, can you spell out your name for me, please?
[AGENT][NEUTRAL] [PII], and my name in today's date will be your call reference number.
[CUSTOMER][POSITIVE] OK, good. Thank you so much. Have a wonderful day. Bye for now.
[AGENT][POSITIVE] OK. Well, you're very welcome and I hope you have a very nice day and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Bye
[AGENT][NEUTRAL] Bye-bye.