AccountId: 011433970860
ContactId: 264355cf-f02e-4b29-b22a-00f70932f9ce
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 375739 ms
Total Talk Time (AGENT): 154576 ms
Total Talk Time (CUSTOMER): 118062 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/264355cf-f02e-4b29-b22a-00f70932f9ce_20250227T18:39_UTC.wav
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[AGENT][NEUTRAL] Good afternoon thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, hi, this is [PII] calling from Byron Healthcare. I called regarding a claim.
[AGENT][NEUTRAL] OK. Did you say your name is [PII]?
[CUSTOMER][NEUTRAL] No, it's, [PII]. And first initial to my last name is [PII]. Yes.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And [PII], what is a
[AGENT][NEUTRAL] OK. You did say [PII] Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you. And your callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you. And you have one claim to check status on, is that correct, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, I can help you with that. What is your patient's policy number?
[CUSTOMER][NEUTRAL] So the member ID number is.
[CUSTOMER][NEUTRAL] 01611858 M as in Mike, L as in Lima, right?
[AGENT][NEUTRAL] Thank you one moment while I get the member's information pulled up please.
[AGENT][NEUTRAL] OK, and the information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, member's name is [PII] and date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount.
[CUSTOMER][NEUTRAL] Date of service is [PII] and bill amount is $3750.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm sorry, give me the date one more time, [PII] or [PII]?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] So this claim was received, the received date was [PII].
[AGENT][NEGATIVE] It was processed and denied on the same date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 353-6195.
[AGENT][NEUTRAL] And the reason for the denial on this claim?
[AGENT][NEUTRAL] states outpatient benefits for this calendar year has been met.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] So, do we have to flip this amount to patient?
[AGENT][NEUTRAL] We do not determine patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] OK. So there is no deductible or coinsurance over the claim.
[AGENT][NEUTRAL] Again, the calendar year had the maximum benefit had been met prior to this claim being received.
[CUSTOMER][NEUTRAL] Uh, but policies is still active for the data service.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. Got it.
[AGENT][NEUTRAL] And if you need a copy of this explanation and then if it's harsh, you can print it directly from our portal by going to [PII].
[CUSTOMER][NEUTRAL] OK. Uh
[CUSTOMER][NEUTRAL] Is there any
[CUSTOMER][NEUTRAL] OK. OK. Is there any denial code over there? What's the denial code?
[AGENT][NEUTRAL] If you need a, yeah.
[AGENT][NEUTRAL] I just read you the denial remark.
[AGENT][NEUTRAL] Outpatient benefit for this, there's not a code. That's a remark for the denial. This is not major medical insurance, this is a supplemental policy.
[CUSTOMER][NEUTRAL] Uh, I need to go.
[CUSTOMER][NEUTRAL] There is no
[CUSTOMER][NEUTRAL] So benefits for this year has been only me, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And is there any other claim details like uh do I have check number or anything?
[AGENT][NEGATIVE] There is no check, there was no benefit paid.
[CUSTOMER][NEUTRAL] And when it was processed?
[AGENT][NEUTRAL] This, the date that I gave you, the same date that it was received.
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] No, [PII].
[CUSTOMER][NEUTRAL] OK, [PII]. OK, got it. OK, then that's all I wanted to know. Can I get the call reference number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, Hush.
[AGENT][NEUTRAL] Yeah, she would use my name that I gave you. Again, my name is [PII], first initial to my last name is [PII], along with today's date.
[CUSTOMER][NEUTRAL] Uh, would you please spell it again?
[AGENT][NEUTRAL] [PII] is my name.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] and today's date, right.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][POSITIVE] OK. You're welcome, [PII]. OK. Well, if that's all I can help you with, thank you again for calling APL and I hope you have a great day.
[CUSTOMER][NEUTRAL] OK. Thank you, [PII]. That's all I wanted to know.
[CUSTOMER][POSITIVE] Have a great day too. Bye.
[AGENT][POSITIVE] Thank you