AccountId: 011433970860
ContactId: 26818d1d-eff8-471d-92cf-9638c1c80da9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 317450 ms
Total Talk Time (AGENT): 141221 ms
Total Talk Time (CUSTOMER): 124525 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/26818d1d-eff8-471d-92cf-9638c1c80da9_20250117T16:29_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from Bro's office. I want to check a claim status. Could you please help me with this?
[AGENT][POSITIVE] It would be my pleasure to assist you, [PII]. What is a good callback number?
[CUSTOMER][NEUTRAL] [PII]. It's a direct line?
[AGENT][NEUTRAL] [PII]. What were the last 4?
[CUSTOMER][NEUTRAL] And before
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, I'll repeat. [PII].
[AGENT][POSITIVE] [PII]. Got it. Thank you, [PII]. I apologize for that.
[CUSTOMER][NEUTRAL] Mhm. And can you please help me your name again, spell me your name?
[AGENT][NEUTRAL] Sure. My name is [PII].
[CUSTOMER][POSITIVE] Nice name, [PII]. Thank you so much for your name.
[AGENT][NEUTRAL] Well, thank you, [PII]. And what is the policy number for the patient, please?
[CUSTOMER][NEUTRAL] Yeah, I'll give you the policy number. The policy number is
[CUSTOMER][NEUTRAL] 02449598.
[AGENT][NEUTRAL] Thank you, [PII] and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] The patient's first name is [PII]. Last name is [PII], sorry.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] All right, thank you, and you were needing claim status?
[CUSTOMER][NEUTRAL] Yes, I want to claim status. What is the denied reason?
[AGENT][NEUTRAL] Well
[AGENT][POSITIVE] It would be my pleasure to assist you. Do you have that claim number or date of service?
[CUSTOMER][NEUTRAL] yeah, data service is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Build out.
[CUSTOMER][NEUTRAL] The bill amount is $1,147 even.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the name of the facility, please?
[CUSTOMER][NEUTRAL] It's uh Saint Mary's Segar Hospital.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] [PII], I'm showing that we did receive that claim on [PII]. It was, I'm sorry, on [PII]. It was processed on [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim was denied.
[AGENT][NEUTRAL] The benefit maximum for that data service has been met.
[CUSTOMER][NEUTRAL] The benefit
[AGENT][NEUTRAL] The benefit maximum for that data service has been met.
[CUSTOMER][NEUTRAL] I think for the date of service has been, sorry, could you please repeat the benefit max for the date of service?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Has been met.
[AGENT][NEUTRAL] In other words, we pay the maximum benefit for that data service.
[CUSTOMER][NEUTRAL] Has been made, right?
[CUSTOMER][NEUTRAL] OK, for this one, do we have to send the claim?
[AGENT][NEUTRAL] There's no benefits available. Um, we've already maxed out that benefit.
[CUSTOMER][NEUTRAL] OK, so the patient don't have the uh benefits, right, for this coverages, for the of service.
[AGENT][NEUTRAL] They, they do have benefits for that coverage. The benefit is a per calendar day benefit, and we received a claim prior to receiving your claim and paid that maximum benefit. Therefore, the benefit has been maxed out.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For that day
[CUSTOMER][NEUTRAL] Then if it has been maxed out. OK, got it. For the date of service. OK. So the denied balance is patient responsibility, right?
[AGENT][NEUTRAL] No, we don't determine patient responsibility. We're not major medical. That would be determined by the provider.
[CUSTOMER][NEUTRAL] So it's. OK, no problem. As we have not received any uh partial payment, do we have option to send an appeal for this one?
[AGENT][NEUTRAL] You have an option for an appeal. The appeal time frame is 180 days from the date of denial.
[CUSTOMER][NEUTRAL] So denial date, can you please help me that [PII], right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, so we are term filing. Can you, can you please help me with the fax number so can we send an appeal for this one?
[AGENT][NEUTRAL] The appeal fax number is 877.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] I'll repeat. [PII], right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. Just bear with me, let me check.
[CUSTOMER][NEUTRAL] OK, no problem. We send an appeal for this one. And uh can I get the call reference number for this one?
[AGENT][NEUTRAL] Call reference number is my name and today's date, and I spell my name. I think I've already spelled it for you, didn't I?
[CUSTOMER][NEUTRAL] Yes, the, your first name is [PII], right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] All the CRL and the today's date, right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Thank you so much for the information and bye. Have a good day. Enjoy the rest of the day and enjoy your weekend. Bye, [PII].
[AGENT][POSITIVE] Uh, [PII], it's a pleasure to assist you with that claim status. Thank you for calling APL. I hope you enjoy your weekend as well. Take care.
[CUSTOMER][NEUTRAL] Bye.