AccountId: 011433970860
ContactId: 2de02868-2d20-4647-aa4f-a4a3c3dbb989
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 587679 ms
Total Talk Time (AGENT): 210162 ms
Total Talk Time (CUSTOMER): 248583 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/2de02868-2d20-4647-aa4f-a4a3c3dbb989_20250620T12:41_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling for Olive Branch Emergency physicians LLC. I verify the UB and this call is made for additional information about the denial. Please note the call will be monitored and recorded for quality and training purposes.
[AGENT][NEUTRAL] Alright, [PII], go ahead and give me your policy number.
[CUSTOMER][NEUTRAL] The policy number is 01838977.
[AGENT][NEUTRAL] Alright, [PII], thank you for that information. Now while I'm pulling this up, go ahead and give me a good return telephone call number, please.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sure, the callback number is [PII], and that's a direct line.
[AGENT][NEUTRAL] Alright, [PII], thank you for all that information. Now, your patient's name and date of birth today, please.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's [PII] I'm sorry, it's uh [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Alrighty, thank you so much for that, [PII]. Looks like [PII] is the insured on this medical supplemental plan, and you did say you wanted to check the status of a claim. Is that correct?
[CUSTOMER][NEUTRAL] Yeah, like it but.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Master
[AGENT][NEUTRAL] And that data of service?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] And how much is your bill for?
[CUSTOMER][NEUTRAL] I'm sorry, uh, the bill amount is going to be.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][POSITIVE] Alrighty.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's $1,926 even.
[AGENT][NEUTRAL] Alright, give me just a moment. Let me locate that bill. It's for 1926. Let's see.
[CUSTOMER][NEUTRAL] yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] last name.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Where's your bill phone for 1926?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Where's your bill gonna be from? What's the provider name?
[CUSTOMER][NEUTRAL] Sure, the provider name is going to be [PII]. May I get your name for my documentation purpose?
[AGENT][NEUTRAL] I'm sorry, I did not catch that provider name.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII], OK, [PII].
[AGENT][NEUTRAL] Uh, because I'm looking to try to find that claim, let's see, 19.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] 40 minutes
[CUSTOMER][NEUTRAL] I like and I just have.
[AGENT][NEUTRAL] 26.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Mm, give me, give me just a moment I'm trying to find your claim. I don't see anything for 1926 in our system here at all.
[CUSTOMER][NEUTRAL] Yeah they don't.
[CUSTOMER][NEUTRAL] Uh-huh. One moment.
[CUSTOMER][NEUTRAL] I do have a claim number I provide you that.
[AGENT][NEUTRAL] Yeah, go ahead and give me that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, the claim number is 360.
[CUSTOMER][NEUTRAL] 9573 uh I do see your bill amount of $1870 even.
[AGENT][NEUTRAL] That's what I'm, that's what I'm seeing. OK, let's see.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Yeah, because I'm looking for your amount and I can't find it. OK, let's see.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Alright, we do have that claim in-house and the reason you said you just wanting to know why it was denied, uh, this patient has a per occurrence benefit. What that means is everything for that diagnosis, they only allow $200 every 90 days. So this patient had already maxed out that that benefit on this claim, so there will be no payment because there's no benefit available.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] So do you mean to say that the benefit limit has been exceeded?
[AGENT][POSITIVE] Yes, ma'am. That's correct, [PII].
[CUSTOMER][NEUTRAL] So may I know the allowed limit?
[AGENT][NEUTRAL] The dollar limit percurrence is 200.
[CUSTOMER][NEUTRAL] But as the checking for this code, I do not see we have received any payment or letters.
[AGENT][NEGATIVE] No, you're not gonna get any payment because there's nothing available. It's been maxed out.
[AGENT][NEUTRAL] There will be no payment on your claim.
[CUSTOMER][NEGATIVE] Yeah, for checking on my end, uh, since you said, uh, the payment has been maxed out, which is of $200 has been maxed out every 90 days. I do see that, uh, we have not received any payment, uh, that is over $200 every 90 days.
[AGENT][NEUTRAL] Right, it went to a different provider, so it's already maxed out before we got your billing in so you're not gonna get any payment there's nothing available for payment it went to a different provider.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So could you please give me a moment, please?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Mhm. Thank you, [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you for staying connected. I appreciate your patience. So, could you please verify the patient account number is [PII]?
[AGENT][NEUTRAL] And I'm sorry, what, what type of information was that [PII]?
[CUSTOMER][NEUTRAL] And account number. Could you please verify the patient account number?
[AGENT][NEUTRAL] No, ma'am, I wouldn't have that on my system.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So just to verify, uh, may I know if it's for the same date of service?
[AGENT][NEUTRAL] The same day of service for
[AGENT][NEUTRAL] Your total bill 285?
[CUSTOMER][NEUTRAL] Different provider?
[AGENT][NEUTRAL] I'm sorry, what was that [PII]?
[CUSTOMER][NEUTRAL] So it is underpaid under a different uh provider, am I right? That's why it has been exceeded.
[AGENT][NEUTRAL] Yes, that is why you will not be getting any payment on that particular claim. It went to a different provider, but the patient has maxed out on the benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello
[CUSTOMER][NEUTRAL] So may I know if it's under a different tax ID or same tax ID?
[AGENT][NEUTRAL] Different, different provider.
[CUSTOMER][NEUTRAL] All right. So just to verify the, for the filing limit is 180 days from the last process date.
[AGENT][NEGATIVE] Yes, we do not have a timely buying limit here at all.
[AGENT][NEGATIVE] And it looks like we've denied your claim twice.
[CUSTOMER][NEUTRAL] All right. Uh, so could you please verify the mailing address for Napi. It's a [PII].
[AGENT][POSITIVE] That is correct, Miss [PII].
[CUSTOMER][NEUTRAL] So just to verify you're unable to take that for your process since uh it has been paid out of the different provider and different tax ID for the same bit of service, am I right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So may I know the claim number? Is there any claim number under which it has been already matched up?
[AGENT][NEUTRAL] 354-883-6.
[CUSTOMER][NEUTRAL] 271
[CUSTOMER][NEUTRAL] Mhm. 354-883-6. Am I right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] All right, could you please help me with the name for my documentation purposes once again, please?
[AGENT][NEUTRAL] My name is [PII], that's spelled [PII] yes. And is that all I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, the reference number, please?
[AGENT][NEUTRAL] We do not give reference number [PII], but you can use my name in today's date, OK?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] All right, less it. Thank you so much for our lovely assistance and have a great day.
[AGENT][POSITIVE] You as well, [PII], and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Bye bye