AccountId: 011433970860
ContactId: 33738160-bad4-41b4-9af7-7a9d82d5bae0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 274940 ms
Total Talk Time (AGENT): 115147 ms
Total Talk Time (CUSTOMER): 60327 ms
Interruptions: 0
Overall Sentiment: AGENT=2.3, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/33738160-bad4-41b4-9af7-7a9d82d5bae0_20250313T16:34_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] Um, yes ma'am. I'm trying to see if you have received a claim for a patient of mine, please.
[AGENT][NEUTRAL] OK, so you're calling from a provider's office and you're wanting to see if we have received a claim for a member, is that correct?
[CUSTOMER][POSITIVE] That's correct.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number, please, [PII].
[CUSTOMER][NEUTRAL] 02458649
[AGENT][NEUTRAL] OK thank you one moment while I get uh the member's information pulled up please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK 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 date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her, please?
[CUSTOMER][NEUTRAL] Data services [PII]. billed amount is $6,531.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so this claim was received, [PII]. The claim number is going to be 3547087. It was received on 125, processed and denied on 129.
[AGENT][NEUTRAL] And one moment, I'll give you the denial remark.
[AGENT][NEUTRAL] The reason for the denial on this claim states outpatient benefit for this calendar year has been met.
[CUSTOMER][NEUTRAL] OK. Um, does that mean that we can bill the patient for this remain remaining amount?
[AGENT][NEUTRAL] Now, we do not determine patient responsibility, that would be up to the provider.
[CUSTOMER][POSITIVE] OK. All right, perfect, thank you.
[AGENT][NEUTRAL] Yes, I am.
[AGENT][POSITIVE] You're welcome. And is there any other, anything else rather that I could help you with?
[CUSTOMER][NEUTRAL] Do you
[CUSTOMER][NEUTRAL] Um, do you show where you all have sent us an EOB for that? Because in our system we, we don't have anything back from you all.
[AGENT][NEUTRAL] Yes, that would have been mailed out um the night or the day rather after processing. Now, if you need a copy of that explanation of benefits, you can go to our portal and print it, [PII]. Our portal website is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect. Thank you so much.
[AGENT][POSITIVE] Well, you are certainly very welcome. And again, is there anything else that I can help you with?
[CUSTOMER][NEUTRAL] Um, just a call reference number, please.
[AGENT][NEUTRAL] Yes, ma'am. It would be my name along with today's date.
[CUSTOMER][POSITIVE] Thank you so much for your help.
[AGENT][POSITIVE] Well, you are certainly very welcome and again, thank you for calling APL. I hope you have a wonderful rest of your day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye.