AccountId: 011433970860
ContactId: 311d67ac-6f8c-430f-abfa-afafa80e84d4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 229639 ms
Total Talk Time (AGENT): 103484 ms
Total Talk Time (CUSTOMER): 45883 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/311d67ac-6f8c-430f-abfa-afafa80e84d4_20250303T14:20_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi I have a question about a claim.
[AGENT][NEUTRAL] OK, you're needing claim status or clarification on the denial?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Um, clarification on the denial.
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] Yes, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And what is the member's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] 02100475
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] [PII] good [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] 12 5 2024986 even.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And you said that you do already have the claim number?
[CUSTOMER][NEUTRAL] Um, no, I just have the to now. I don't actually have the EOB in front of me.
[AGENT][NEUTRAL] OK, so the claim number is 356-4954.
[AGENT][NEUTRAL] And yes ma'am this claim was denied and the reason for the denial on this claim states outpatient benefit for this calendar year has been met.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Mhm. Outpatient benefit.
[CUSTOMER][NEUTRAL] So then does it because.
[CUSTOMER][NEUTRAL] Does it become PR?
[AGENT][NEUTRAL] This
[AGENT][NEUTRAL] This is a I'm sorry.
[AGENT][NEUTRAL] No, ma'am. We do not determine patient responsibility. We are not a major medical insurance. This is only a supplemental plan to their primary insurance.
[CUSTOMER][NEUTRAL] I just went to it
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well that's what I was asking, does it become patient responsibility if you guys don't cover it?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] And we didn't, yes, ma'am, we do not determine patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you need a copy of the explanation of benefits, [PII], you can print that by going to our portal at [PII].
[CUSTOMER][NEUTRAL] That was [PII]?
[AGENT][NEUTRAL] Yes ma'am, uh-huh.
[CUSTOMER][POSITIVE] Perfect and then just a call reference number, huh?
[AGENT][NEUTRAL] Sure, you would use my name along with today's date.
[CUSTOMER][NEUTRAL] What was your name again, huh?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Well, you're very welcome. So if that's all then, [PII], that I can help you with, thank you again for calling APL and I hope you have a great day.
[CUSTOMER][NEUTRAL] You too hon.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye-bye.