AccountId: 011433970860
ContactId: 2bc5ed6b-5672-4ce0-a6bd-d43e48c16814
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 504040 ms
Total Talk Time (AGENT): 134316 ms
Total Talk Time (CUSTOMER): 207316 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/2bc5ed6b-5672-4ce0-a6bd-d43e48c16814_20250421T12:30_UTC.wav
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[AGENT][NEUTRAL] APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, my name is [PII] calling for the provider to check on the claim status. Please be informed that this call has been.
[AGENT][NEUTRAL] Policy number, [PII]?
[CUSTOMER][NEUTRAL] Yeah, let me just give me the uh disclaimer first. Please be informed that this call is being recorded and monitored for quality and training purposes, and the policy number is 022879777.
[AGENT][NEUTRAL] What's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] It's [PII]. No extension it's a direct line.
[AGENT][NEUTRAL] And what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] The patient's name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] OK, and you're checking claim status for what date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the amount?
[CUSTOMER][NEUTRAL] Yeah, sure. Just a moment. The amount is fetching.
[CUSTOMER][NEUTRAL] And then, could you please tell me your name once again? I didn't catch your name.
[AGENT][NEUTRAL] Give me the provider, the pro the total amount please.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, the amount is $1,699.88.
[AGENT][NEUTRAL] My name is [PII], and one moment, let me check the status for you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This claim was received [PII].
[AGENT][NEUTRAL] Processed [PII].
[AGENT][NEGATIVE] And I show that no payment was made on this claim. The reason says that the maximum outpatient benefit is exhausted.
[CUSTOMER][NEGATIVE] Uh, so the service has been exhausted. The maximum service has been exhausted.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] to
[AGENT][NEUTRAL] And did you need the claim number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh yeah, sure. Just a moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And do you have any denial dates?
[AGENT][NEUTRAL] It was the date that I just provided, the receipt date and the process date.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. So you don't have the denial date.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What do you have as a process date?
[CUSTOMER][NEUTRAL] What will be the claim number?
[AGENT][NEUTRAL] Do you have the process date?
[CUSTOMER][NEUTRAL] OK. What will be the claim number?
[AGENT][NEUTRAL] OK, do you have the process date, [PII]? It's [PII]. That's the denied date.
[CUSTOMER][NEGATIVE] Uh, no.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 359-063-2.
[AGENT][NEUTRAL] And you can also check status online at [PII] as well. And did you have any other questions?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Uh, yeah, I have a few questions with me. Uh, let me just reconfirm the claim number once again. It's 359-0632. Am I right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So, uh,
[CUSTOMER][NEUTRAL] So what are the allowed services amount for time frame?
[AGENT][NEUTRAL] What is the maximum outpatient benefit?
[CUSTOMER][NEUTRAL] And I'm asking about what are the allowed services amount per time frame.
[AGENT][NEUTRAL] OK, that's what I'm saying it was an outpatient service, so the maximum outpatient benefit is up to $3000 per calendar year. That's already been used.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Outpatient and.
[CUSTOMER][NEUTRAL] $3000 is the maximum amount, am I right?
[AGENT][NEUTRAL] Per calendar year, correct.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] See
[CUSTOMER][NEUTRAL] OK, and it has been used.
[CUSTOMER][NEUTRAL] So, could you please tell me when was the last service bill?
[AGENT][NEUTRAL] From a different provider we received it in in [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. Am I right?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] All [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what will be the date? The date is [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what is the period to build the service?
[AGENT][NEUTRAL] What is the period to build the service? Are you asking if there's a timely filing limit?
[CUSTOMER][NEUTRAL] Uh, no, I'm asking the time period to build the service.
[AGENT][NEUTRAL] OK, uh, what do you mean when you say that?
[CUSTOMER][NEUTRAL] Well I
[CUSTOMER][NEUTRAL] OK. What will
[CUSTOMER][POSITIVE] Yeah, yeah, you're a lot with the timely filing to build the service.
[AGENT][NEGATIVE] There's no timely filing limit.
[CUSTOMER][NEUTRAL] OK. And what will be the time you're filing to submit the corrected claim?
[AGENT][NEGATIVE] There's no timely filing limit.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, just a moment. And what will be the mailing address to submit the corrected claim?
[AGENT][NEUTRAL] It's the same address [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And that
[AGENT][NEUTRAL] And the zip code is [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and uh so what would be the timely filing to submit an appeal?
[AGENT][NEGATIVE] 180 days from the date it was denied.
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Excuse me, sorry, and what will be the mailing address to submit an app? It will be the same?
[AGENT][NEUTRAL] The same address?
[CUSTOMER][NEUTRAL] OK. And is there any specific form for an appeal?
[AGENT][NEGATIVE] There is not.
[CUSTOMER][NEUTRAL] And this denied you will be required by submitting an appeal.
[CUSTOMER][NEUTRAL] Or claim?
[AGENT][NEUTRAL] Submit any documentation you feel.
[AGENT][NEUTRAL] Necessary for us to review the appeal.
[CUSTOMER][NEUTRAL] Not
[CUSTOMER][NEUTRAL] Uh, no, I'm asking about the denied EOB. The denied EOB is required while submitting a claim or an appeal.
[AGENT][NEGATIVE] You can send it if you would like. We already have it. I mean, it's gonna be denied again because the benefits are maxed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. What will be the clear call reference number?
[AGENT][NEUTRAL] It's my name in today's date and any other questions, [PII]?
[CUSTOMER][NEUTRAL] Uh, no, I do have one more claim with me. Could you please help me with that?
[AGENT][POSITIVE] All righty. Thank you.
[AGENT][NEUTRAL] The policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, sir. Just a moment, it's fetching.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK thanks.
[CUSTOMER][NEUTRAL] I don't
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm gonna place you on a brief hold while you search for that one moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, uh, so the next member ID is, are you there?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.