AccountId: 011433970860
ContactId: 2236e184-5213-4782-a60b-d28a69f64988
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 227809 ms
Total Talk Time (AGENT): 97767 ms
Total Talk Time (CUSTOMER): 131634 ms
Interruptions: 5
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/2236e184-5213-4782-a60b-d28a69f64988_20250305T14:23_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling for Samaritan Hospital to check on a claim to our status.
[AGENT][NEUTRAL] Mm, sure, I can assist you with claims Mr. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, my callback number it's gonna be [PII].
[AGENT][NEUTRAL] OK, and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Sure, so the patient's policy number is gonna be.
[CUSTOMER][NEUTRAL] 133083.
[CUSTOMER][NEUTRAL] 6 M as in Mike. L as in Lima, 8.
[AGENT][NEUTRAL] Mr. [PII], you're calling about the same claim?
[CUSTOMER][NEUTRAL] Uh, yes, yes, so.
[AGENT][NEUTRAL] How may I help you?
[CUSTOMER][NEUTRAL] OK, uh, so the claim was denied for the outpatient benefits. So could you please let me know whether, uh, the benefits have been exhausted and the units or the amounts.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's gonna be the amount.
[CUSTOMER][NEUTRAL] And um.
[AGENT][NEUTRAL] Um, let me go ahead and get that amount for you. And this is not a guarantee of payment, just a verification of coverage.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the outpatient maximum was let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, the calendar year maximum was $750.
[CUSTOMER][NEUTRAL] $350 and the total $750 has been met, right?
[AGENT][POSITIVE] Correct. That's been costed.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, and could you please let me know when it was met? Can I get the date?
[AGENT][NEUTRAL] We cannot, we cannot release that information.
[AGENT][NEUTRAL] Because it's not gonna be to to your provider or from your provider, so I cannot give information from another provider.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Alright, so the, I mean the benefits was not met with this provider, right? It was with a different one or I just wanna confirm once again.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] More than likely it's with a different one correct yes um this is for any outpatient service so it could be with any claims that it was exhausted at the time we received your claim it was already exhausted.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, OK, thank you so much. Also, for my documentation purpose, can I have the appeal mailing address?
[AGENT][NEUTRAL] OK, that is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Alright, got that and.
[AGENT][NEUTRAL] And you have 180 days from the decision date to submit an appeal.
[CUSTOMER][NEUTRAL] Can I
[CUSTOMER][NEUTRAL] OK. It is 180 days, right? I just from the denial date, right?
[AGENT][NEUTRAL] Mhm, yes.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and may I know the denial date? It was [PII], right?
[AGENT][NEUTRAL] Um, let me go back to the claim. One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, the denial date is [PII].
[CUSTOMER][POSITIVE] Got that. Thank you so much. So alright, can I have the uh character claim timely filing limit?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] People
[AGENT][NEUTRAL] Um, we don't have time to find a limit for a corrected claim.
[CUSTOMER][POSITIVE] Alright, thank you so much. OK, yeah, I got that and any more questions here, so thank you so much for assisting me. So. Take care. Bye-bye.
[AGENT][POSITIVE] You're welcome. Thank you for calling APR. Have a good day, Mr. [PII]. Bye-bye.