AccountId: 011433970860
ContactId: 2ee860ae-94b4-4478-a220-e066ec6f2ca1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 661369 ms
Total Talk Time (AGENT): 169517 ms
Total Talk Time (CUSTOMER): 273457 ms
Interruptions: 9
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/2ee860ae-94b4-4478-a220-e066ec6f2ca1_20250515T16:47_UTC.wav
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[CUSTOMER][NEUTRAL] I was.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] from the provider's office. How are you today?
[AGENT][POSITIVE] I'm good how are you?
[CUSTOMER][POSITIVE] Hey, thanks for asking. I'm fine here.
[AGENT][POSITIVE] OK, what can I help you with today?
[CUSTOMER][NEUTRAL] Yeah, I'm looking for a claim status for member [PII].
[AGENT][NEUTRAL] Can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Callback number is [PII].
[CUSTOMER][NEUTRAL] Yeah, the policy number is 02292653.
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] the.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] U M
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And can I get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Do you have a different name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] top 3 of my.
[AGENT][NEUTRAL] And do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] Data service is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] He's suffering from.
[AGENT][NEUTRAL] You said [PII] correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you have the total bill amount?
[CUSTOMER][NEUTRAL] That was $865 even 865. OK.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Do you need the claim number?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, it's 358.
[AGENT][NEUTRAL] 3407.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me one moment to look it up.
[CUSTOMER][NEUTRAL] 0.
[AGENT][NEUTRAL] It looks like we received this claim on.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]. It was processed on [PII].
[CUSTOMER][NEUTRAL] I do.
[CUSTOMER][POSITIVE] Thank you man thanks.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This claim was denied because we need to, you need to provide copies of the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Go to the bathroom.
[CUSTOMER][NEUTRAL] OK. Can I get the payer ID?
[AGENT][NEUTRAL] Our payer ID is 60801.
[CUSTOMER][NEUTRAL] Can I get the call reference number?
[AGENT][NEUTRAL] We don't have a call reference number, but you can use my name and my last initial, so [PII], and today's date.
[CUSTOMER][NEUTRAL] OK. Shall I go to the next number.
[AGENT][NEUTRAL] You have another claim number or another policy?
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Yeah, one moment.
[CUSTOMER][NEUTRAL] I have a different patient with me now.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me finish up the notes on this patient and then I will help you with your next one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] funny.
[CUSTOMER][NEUTRAL] Well.
[CUSTOMER][NEUTRAL] On my way.
[CUSTOMER][NEUTRAL] I'm really that.
[CUSTOMER][NEUTRAL] Hey.
[CUSTOMER][NEUTRAL] yeah.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Hey
[CUSTOMER][NEUTRAL] When
[CUSTOMER][NEUTRAL] I'm not.
[CUSTOMER][NEUTRAL] it.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] All right, and what is the other policy number?
[CUSTOMER][NEUTRAL] Hello, hello?
[CUSTOMER][NEUTRAL] You know,
[CUSTOMER][NEUTRAL] Yeah, that was, that was 02521722.
[AGENT][NEUTRAL] 02521722
[CUSTOMER][NEUTRAL] Yeah, right.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] And do you have the claim number?
[AGENT][NEUTRAL] Or the date of service?
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The claim number is 3583276.
[AGENT][NEUTRAL] 3583276
[CUSTOMER][NEUTRAL] Yeah, right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like we received that claim on [PII] and it was processed on the same day, [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] That claim was denied because the maximum benefit payable for that data service has been met.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Why
[CUSTOMER][NEUTRAL] Yeah, is that a dollar maximum or is it maximum?
[AGENT][NEUTRAL] That was the maximum benefit.
[CUSTOMER][NEUTRAL] To go or what.
[AGENT][NEUTRAL] The maximum benefit payable for that date of service was met already. That's why the claim was denied.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, are you secondary for this number, right? Then was the claim denied for such reason?
[AGENT][NEUTRAL] Do you have another patient?
[CUSTOMER][NEUTRAL] No, you are a secondary for this number, right?
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Yeah, you are a secondary payer for this member, right?
[AGENT][NEUTRAL] The payer ID number?
[CUSTOMER][NEUTRAL] right.
[AGENT][NEUTRAL] Hello? I can't hear you.
[CUSTOMER][NEUTRAL] No, I'm asking about, you are a primary or secondary for this member.
[AGENT][NEUTRAL] Um, this is.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] This is a secondary policy.
[CUSTOMER][NEGATIVE] Yeah, then why the claim got denied for such a reason? Because the primary leftover is a coincidence. Then why the claim got denied for maximum benefit was exhausted.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] What the.
[AGENT][NEUTRAL] It had already been used for that date of service.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, on which data that was used.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] It looks like she is used.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] $200 towards her outpatient.
[AGENT][NEUTRAL] For this year.
[CUSTOMER][NEUTRAL] Yeah, on which state of service.
[AGENT][NEUTRAL] That's what she's used for the full year.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Before that date of service she has for the the claim that you gave me.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Her maximum was met already.
[CUSTOMER][NEUTRAL] I do.
[AGENT][NEUTRAL] I can't give in I can't give any information on claims other than the one that you're asking for.
[CUSTOMER][NEUTRAL] That can I get the time limit.
[CUSTOMER][NEUTRAL] that.
[AGENT][NEUTRAL] Sorry, what?
[CUSTOMER][NEGATIVE] I think I'm wrong.
[CUSTOMER][NEUTRAL] Yeah, I'm asking about the time if I limit to submit an appeal.
[AGENT][NEUTRAL] I'm sorry, can you talk just a little bit slower? There's noise that I can't hear you.
[CUSTOMER][NEUTRAL] So this
[CUSTOMER][NEUTRAL] yeah
[CUSTOMER][NEUTRAL] Yeah, can I get the time limit to submit an appeal?
[AGENT][NEGATIVE] Oh, OK, there is no timely filing.
[CUSTOMER][POSITIVE] OK, then. Thank you. Thank you for your assistance. Have wonderful day for you.
[AGENT][NEUTRAL] Alright, is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] Alright. Well, thank you so much for calling [PII]. I hope you have a great day.
[CUSTOMER][NEUTRAL] Yeah, you too. Bye.
[AGENT][NEUTRAL] Alright, bye.