AccountId: 011433970860
ContactId: 32210a1b-22fa-4ced-9ae3-f92d87b3fd32
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 502440 ms
Total Talk Time (AGENT): 117299 ms
Total Talk Time (CUSTOMER): 207018 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/2025/01/03/32210a1b-22fa-4ced-9ae3-f92d87b3fd32_20250103T18:14_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] calling from provider software check on a claim data clarification.
[AGENT][NEUTRAL] OK [PII], I can help you with the claim. Can you please give me your callback number just in case the call is disconnected?
[CUSTOMER][NEUTRAL] Sure, my callback number is [PII] with the [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what is the patient's name?
[CUSTOMER][NEUTRAL] Patient's name is [PII].
[AGENT][NEUTRAL] And then what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] My date of birth is [PII].
[AGENT][NEUTRAL] And her policy number please?
[CUSTOMER][NEUTRAL] It is 01658237 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] Thank you. And then what is the date of service?
[CUSTOMER][NEUTRAL] Yeah, it is [PII] and the charge amount is $471 even.
[AGENT][NEUTRAL] OK, and what's the charges after primary paid their part?
[CUSTOMER][NEUTRAL] Um, it is $132.34.
[AGENT][NEUTRAL] Thank you and then what is the facility that you're calling for?
[CUSTOMER][NEUTRAL] Uh, I'm calling from SDI Diagnostic imaging.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] The full name.
[CUSTOMER][NEUTRAL] Of the first lady.
[CUSTOMER][NEUTRAL] Is STI diagnostic imaging stern, Drake, Isabel and Associates PA.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, [PII], I'm gonna put you on a brief hold while I look up that claim for you and I'll be right back.
[CUSTOMER][POSITIVE] Yeah, take your time.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi [PII], this is [PII]. Um, I've got the claim pulled up for you. The claim number is 3503976. Claim was denied because the benefit was maxed for the data service.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh, it is made by uh value or by units.
[AGENT][NEUTRAL] It just says that the benefit was maxed.
[CUSTOMER][POSITIVE] Benefits for max.
[CUSTOMER][NEUTRAL] Uh, could you please provide me the dinner date?
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] Claim number 5972683.
[AGENT][NEUTRAL] Let me get that for you.
[CUSTOMER][NEUTRAL] 102.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] Date it was processed was [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 72
[CUSTOMER][NEUTRAL] One.
[CUSTOMER][NEUTRAL] 912 right.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, and uh.
[CUSTOMER][NEUTRAL] Can I get your name?
[AGENT][NEUTRAL] My name is [PII]
[AGENT][NEUTRAL] And the call references my name and today's date.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, before that, uh, uh, I just need some more clarification about the denial. Um, could you please provide me any units, uh.
[CUSTOMER][NEUTRAL] How many units allowed for the for this service?
[CUSTOMER][NEUTRAL] 59-7281.
[CUSTOMER][NEUTRAL] 03 R.
[CUSTOMER][NEUTRAL] Too there.
[AGENT][NEUTRAL] Uh, yes, I'm looking, um, so.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it's not units. What it is is this policy and this is just to verify benefits, it's not a guarantee of payment. This policy covers deductible, co-pay and co-insurance. They have an outpatient per calendar day amount of $500.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] About.
[AGENT][NEUTRAL] The $500 was already met for that date of service.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Ah
[CUSTOMER][NEUTRAL] August $2500.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] This, uh, made by the value, right? Dollar amount.
[AGENT][NEUTRAL] There that wasn't the only claim sent in for that day and the $500 was paid to another claim.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And was met for the day.
[CUSTOMER][NEUTRAL] OK, it is under the same provider or a different provider?
[AGENT][NEGATIVE] I can't give that information out it's private information.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Is that uh.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Can I, I don't ask for the payment details. I just ask, uh, is that paid to the same facility or the different facility?
[CUSTOMER][NEUTRAL] That's what I'm asking.
[AGENT][NEGATIVE] I can't get that information that's private information.
[CUSTOMER][NEUTRAL] OK, but, uh, the dollar dollar amount $500 as made for another claim, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm, OK, and the reference number for this call is your name and today today today's date, right?
[AGENT][NEUTRAL] Yes, that's
[AGENT][POSITIVE] Yes, sir, that's right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you, [PII]. Thank you for assisting me today. Have a wonderful day.
[AGENT][POSITIVE] You too [PII] you have a blessed one thanks for calling APL.
[CUSTOMER][POSITIVE] Bye take care.
[AGENT][NEUTRAL] Bye-bye.