AccountId: 011433970860
ContactId: 3678a316-1888-4c3b-93ad-796d6e65a09e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 445339 ms
Total Talk Time (AGENT): 124616 ms
Total Talk Time (CUSTOMER): 256427 ms
Interruptions: 8
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/3678a316-1888-4c3b-93ad-796d6e65a09e_20250328T13:57_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, so this is [PII] calling from By Scott to check on time status.
[AGENT][NEUTRAL] OK, thank you and Mr. [PII], uh, may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] I said.
[CUSTOMER][NEUTRAL] Sure. My callback number is [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Sure, the patient's policy number is 01896422.
[CUSTOMER][NEUTRAL] I
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] [PII] and the total bill amount is $3,026.91.
[CUSTOMER][NEUTRAL] That's
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I think for future you can check claim status online through our website at [PII] and that's just optional and bear with me, let me pull the EOB, OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I I I.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm still waiting on the system. One moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hello
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, it looks like we processed the claim on [PII] and the claim was denied.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] The reason for this denial is that the outpatient benefits for the calendar year has been met.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, dinner as an outpatient.
[AGENT][NEUTRAL] Outpatient benefits for the calendar year?
[CUSTOMER][NEUTRAL] Visits are met.
[AGENT][NEUTRAL] Has been that.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You
[CUSTOMER][NEUTRAL] And uh please may I get the, how many visits per year for patient policy?
[AGENT][NEUTRAL] It's not this, it's dollar amount. Bear with me just a second, let me get that information for you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yeah, it's lost his maximum benefit, OK? One moment.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well.
[CUSTOMER][NEUTRAL] Hi [PII], this is Doctor.
[AGENT][NEUTRAL] OK, so the maximum benefit was 2000 per cover person per calendar year.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Today
[AGENT][NEUTRAL] This is not a guarantee of payment, just a verification of coverage.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] credit
[CUSTOMER][NEUTRAL] So 2000 per year.
[AGENT][POSITIVE] Mhm, correct.
[CUSTOMER][NEUTRAL] This is
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] blue and.
[CUSTOMER][NEUTRAL] The ID is 01. And may I get the claim number, receive date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the received date was [PII]. The claim number is 3573359.
[CUSTOMER][NEUTRAL] be.
[CUSTOMER][NEUTRAL] C
[CUSTOMER][NEUTRAL] OK. And could you confirm you guys process this as a primary or secondary? Thank you. So primary process and they gave a coin insurance of $271.74.
[AGENT][NEUTRAL] Secondary.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So this is also a patient responsibility, right?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] It's up to the provider's discretion. Um, they already use all the benefits, so they don't have any more benefits available with us.
[CUSTOMER][NEUTRAL] So this is a patient response.
[AGENT][NEUTRAL] We're not the major medical. We don't decide what's the patient's responsibility.
[AGENT][NEUTRAL] It's up to the provider's discretion.
[CUSTOMER][NEUTRAL] OK. OK. So, thank you. And uh
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] May I know the last date for this uh maximum benefit? Yes, yes.
[AGENT][NEUTRAL] The last
[AGENT][NEUTRAL] Use, we cannot release that information. I can only give you information pertaining to your claim. When we receive your claim, the benefits were already exhausted, so I can release that information.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] 44,550 for [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, thank you. So, and uh please may I get, get the patient plan name.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] This is a secondary supplemental plan to the major medical.
[CUSTOMER][NEUTRAL] Sure, thank you. And uh please may I get the caller for this call.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][POSITIVE] Thank you, sir. Thank you for your help and uh have a wonderful day and take care.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] You're sir. Thank you for calling APL. Bye-bye, Mr. [PII].
[CUSTOMER][NEUTRAL] No
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, that
[CUSTOMER][NEUTRAL] like.