AccountId: 011433970860
ContactId: 23c91139-af41-455c-84c6-14f720088299
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 366230 ms
Total Talk Time (AGENT): 131283 ms
Total Talk Time (CUSTOMER): 100308 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/23c91139-af41-455c-84c6-14f720088299_20250224T19:48_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], uh, my name is [PII]. I'm calling from providers office to check on a claim status.
[AGENT][POSITIVE] OK, I can definitely help you with the claim status, [PII]. May I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, uh, the best callback number is [PII] and the extension is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Sure, uh, the patient policy number is 02458625.
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Oh, I don't have only one claim with me.
[AGENT][NEUTRAL] OK, can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure, uh, the patient name is [PII], and the date of birth is on [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim and the total bills?
[CUSTOMER][NEUTRAL] Sure, uh, the service is from, uh, [PII], uh, with the total bill amount of $1,122 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Sure, uh, the provider service is the Johns Hopkins All Children's Hospital.
[AGENT][NEUTRAL] OK, so it, uh, so for this claim, it has a date range of [PII], but there's no claim here from [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But there is one from [PII] with your total bills.
[CUSTOMER][POSITIVE] Yes, uh, that's correct actually. Uh, it's [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] With the two CPD codes of, yeah, please go ahead.
[AGENT][NEUTRAL] So I'm showing the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 3555763.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied as the calendar year max for physical speech or occupational therapy has been met.
[CUSTOMER][NEUTRAL] OK. OK. uh, just a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So, um, is it not covered under the basic plan, is that it?
[AGENT][NEUTRAL] It's not that it's not covered. The max has been met.
[CUSTOMER][NEUTRAL] Sorry, uh, you said that deductible?
[AGENT][NEUTRAL] So it's not that the service is not covered. The max has been met, so they've used their benefit for the year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, I got it. Is it made by, uh, like a dollar amount or a, uh, is it?
[AGENT][NEUTRAL] Both, um, the, the benefit was up to $15 per day with a max of 1 day per calendar year for physical speech or occupational therapy facility, and they've used that, that, um, day.
[CUSTOMER][NEUTRAL] OK, so, uh-huh, can you please repeat that, like how many days is the maximum benefits covered what's this?
[AGENT][NEUTRAL] The benefit is up to $15 per day, with a max of 1 day per calendar year. So by the time your claim came in, this benefit was used already, so they can't use it again.
[CUSTOMER][NEUTRAL] OK. Uh, could you please access the email?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] The best fax number is [PII].
[AGENT][NEUTRAL] And that's attention, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][POSITIVE] OK, I'll go ahead and send the um explanation of benefits over to you now. Was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] No, and uh, uh, when can we receive the fax actually?
[AGENT][POSITIVE] Um, I would say to give it at least an hour since it's a fax, but if you don't receive it by the end of day today, um, just give us a call back and we'll be more than happy to resend it for you.
[CUSTOMER][NEUTRAL] OK, sure. Uh, can I get the call, uh, call reference for this claim, [PII]?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK, sure. Thank you for the information, [PII]. Uh, it's really nice talking to you. Have a wonderful day.
[AGENT][POSITIVE] You also and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.