AccountId: 011433970860
ContactId: 254241ae-2ebd-4b0c-9e53-632270c13852
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 195100 ms
Total Talk Time (AGENT): 81777 ms
Total Talk Time (CUSTOMER): 40749 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/254241ae-2ebd-4b0c-9e53-632270c13852_20250204T15:17_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from a provider's office to check on the status of a claim.
[AGENT][POSITIVE] Alright, [PII], I'm happy to check on a claim today. What's the policy number?
[CUSTOMER][NEUTRAL] 02550987
[AGENT][POSITIVE] Thank you for that. Let me pull that up here.
[AGENT][NEUTRAL] And if I could get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you and then what is the data service we're looking for?
[CUSTOMER][NEUTRAL] 1216 24.
[AGENT][POSITIVE] Thank you, build them out.
[CUSTOMER][NEUTRAL] $789.
[AGENT][NEUTRAL] One moment while I just take a look here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it looks like we did receive the claim, um, it was received on [PII].
[AGENT][NEUTRAL] And it looks like the claim was denied. The outpatient benefit max for the calendar year had already been met.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] When was that um remittance mailed out or sent out?
[AGENT][NEUTRAL] It looks like on [PII].
[CUSTOMER][NEGATIVE] It was mailed out one time but you didn't receive the claim until [PII]. That doesn't make sense.
[AGENT][NEUTRAL] I been
[AGENT][NEUTRAL] It was so the benefit for the um calendar year was met on [PII] under a different claim, is that what you're asking me? I'm sorry.
[CUSTOMER][NEUTRAL] No, I asked you when the EOB was sent out stating that it was denied.
[AGENT][NEUTRAL] Oh, I'm so sorry I misunderstood you. OK, on that claim the, yeah, I know that doesn't make sense. You're right, um, that claim was processed on [PII].
[CUSTOMER][NEUTRAL] And I was like, wait a minute.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is that denied as patient responsibility?
[AGENT][NEGATIVE] It, yeah, I mean, it's just denied as the max was met so we don't advise on the patient responsibility.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, is there a reference number to our call?
[AGENT][NEUTRAL] Absolutely, that's gonna be my name with my last initial than today's date. My name again is [PII], that's [PII] Last initial to my name is [PII].
[CUSTOMER][POSITIVE] All right thank you have a good day.
[AGENT][POSITIVE] You you too bye bye.