AccountId: 011433970860
ContactId: 2ef21a85-790d-4af5-b325-50e0fd78681c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 313100 ms
Total Talk Time (AGENT): 120789 ms
Total Talk Time (CUSTOMER): 115924 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/2ef21a85-790d-4af5-b325-50e0fd78681c_20250319T15:49_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII] and I'm calling on behalf of provider's office regarding claims.
[AGENT][NEUTRAL] Sure, I can assist you with claims and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yup. One moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Our callback number is [PII].
[CUSTOMER][NEGATIVE] This is direct line, no extension.
[AGENT][NEUTRAL] OK, and you say you're calling from which facility for my notation, Mr. [PII]?
[CUSTOMER][NEUTRAL] Eli imaging.
[AGENT][NEUTRAL] OK. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Uh, just give me one moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Pulling up.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Could you please spell your name for me?
[AGENT][NEUTRAL] Sure, that's [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One moment, sir.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I pull the member ID. So are you ready?
[AGENT][POSITIVE] Yeah, I'm ready, go ahead.
[CUSTOMER][NEUTRAL] It's 1578522 ML 8.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Member name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] The date of service on the claim is [PII]. The total charge amount on the claim is $288.55.
[AGENT][NEUTRAL] OK, let me see if I can find this, and that was [PII]. And for future, you can check claim status online through our website at [PII] and that's just optional.
[AGENT][NEUTRAL] Um let me pull this ELB.
[CUSTOMER][NEUTRAL] in.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, I'm waiting on the EB.
[CUSTOMER][POSITIVE] OK, sure. Take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, looks like we processed the claim [PII] and the claim was denied. The denial reason is outpatient benefits for the calendar year has been met.
[CUSTOMER][NEUTRAL] Uh, one moment, please. When do you receive the claim?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. And one moment.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the claim was processed on [PII].
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII]. And it was denied on the same date? [PII].
[AGENT][NEUTRAL] It was received on the [PII], processed on the [PII].
[CUSTOMER][NEUTRAL] And the nights stating.
[CUSTOMER][NEUTRAL] Out of network?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Outpatient benefits for the calendar year has been met.
[CUSTOMER][NEUTRAL] Outpatient benefit of the calendar.
[CUSTOMER][NEUTRAL] Has been made.
[AGENT][NEUTRAL] Outpatient benefits for the calendar.
[CUSTOMER][NEUTRAL] So did you, uh, may I know?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, sorry to interrupt you. Uh, could you please, uh,
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Give me the details for annual deductible.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, let me give you the correct denial first because I don't think you got the correct denial. The correct denial is outpatient benefits for the calendar year has been met.
[CUSTOMER][NEUTRAL] Hey
[CUSTOMER][NEUTRAL] For the calendar has been met. OK. Could you please provide me a claim number?
[AGENT][NEUTRAL] Yes, the claim number is 35,462,103,546,210.
[CUSTOMER][NEUTRAL] Could you please provide me your call reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date.
[CUSTOMER][POSITIVE] Thank you so much for for providing me this information. Have a great day. Bye, take care, stay, sir.
[AGENT][POSITIVE] Yes ma'am. You too. Thank you for calling APM. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.