AccountId: 011433970860
ContactId: 3674c6f1-18c1-481b-969a-1a816595dddc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 390119 ms
Total Talk Time (AGENT): 93375 ms
Total Talk Time (CUSTOMER): 94121 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/3674c6f1-18c1-481b-969a-1a816595dddc_20250206T15:47_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, this is [PII], calling from Byra Healthcare Center.
[AGENT][NEUTRAL] OK, and what, what was the name of the care center you're calling from again?
[CUSTOMER][NEUTRAL] Byram Healthcare Center.
[AGENT][POSITIVE] OK thank you um.
[AGENT][NEUTRAL] Can I please get your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][POSITIVE] Thank you, and then how can I help you today?
[CUSTOMER][NEUTRAL] Uh, actually, we have sent a claim to you on [PII] and still we don't receive any EOP from your side. So can you please help me with that?
[AGENT][NEUTRAL] Yes, I can. Can I please get the, the patient's name?
[CUSTOMER][NEUTRAL] Yes. The patient name is [PII].
[AGENT][NEUTRAL] And what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, and [PII]'s policy number?
[CUSTOMER][NEUTRAL] It's 01611858 ML 8.
[AGENT][NEUTRAL] Thank you and then what's the date of service?
[CUSTOMER][NEUTRAL] The rate of services [PII].
[AGENT][NEUTRAL] And the charge amount please?
[CUSTOMER][NEUTRAL] $3750.
[AGENT][NEUTRAL] OK, and what is the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Uh, give me a second.
[CUSTOMER][NEUTRAL] Primary insurance paid $780 and put the $195 in coins.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold, Harm, while I look up this policy for you and the claim number. I'll be right back.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] [PII], can you please spell the first name of your facility, the care center? Can you spell the first name?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][POSITIVE] OK, thank you so much. I'm gonna put you on a brief hold again. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you for holding for me. I do have the claim pulled up. The claim number is 353-619-5.
[AGENT][NEUTRAL] The claim was denied because the benefits for the calendar year had been met and maxed.
[AGENT][NEUTRAL] And if you give me your um fax number I can send you a fax of the EOB.
[CUSTOMER][NEUTRAL] Uh, the claim is denied for?
[AGENT][NEUTRAL] Benefits were maxed out for the calendar year.
[CUSTOMER][NEUTRAL] Um, yes, uh, and what is the denial, uh, code there? It's uh 0 23 or 96.
[AGENT][NEUTRAL] It's D2M0306.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] Uh, can you please provide me a reference number for this?
[AGENT][NEUTRAL] Yes, you can use my name. It's [PII] in today's date.
[CUSTOMER][POSITIVE] OK, thank you, thanks for the information.
[AGENT][NEUTRAL] You
[AGENT][POSITIVE] You're welcome you have a good day and thank you for calling APL bye bye.
[CUSTOMER][NEUTRAL] You too. Monday.