AccountId: 011433970860
ContactId: 3da7b331-5cfb-404b-98a4-bf404a0fb5c4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 270959 ms
Total Talk Time (AGENT): 115136 ms
Total Talk Time (CUSTOMER): 83867 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/31/3da7b331-5cfb-404b-98a4-bf404a0fb5c4_20241231T20:40_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, [PII]. My name is uh [PII], and I'm checking status on a medical claim.
[AGENT][POSITIVE] Well, [PII], it would be my pleasure to help you with that claim status. What is a good callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number?
[CUSTOMER][NEUTRAL] Uh, give me one second here.
[CUSTOMER][NEUTRAL] 01653564
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] [PII], it would be my pleasure to help you with that claim status. What is the date of service for the claim?
[CUSTOMER][NEUTRAL] OK, I have two dates of services. The first one is 6-1324 dollars and the amount of $33.
[CUSTOMER][NEUTRAL] The second one is for 619 and it's for $42.
[AGENT][NEUTRAL] And that's 6:13 was for 38 you said?
[CUSTOMER][NEUTRAL] No, uh, 33.
[AGENT][POSITIVE] 330. I am so sorry. Thank you.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] And that is for a single CPT correct?
[CUSTOMER][NEUTRAL] Yeah, I can check on that. Let me see.
[CUSTOMER][NEUTRAL] It looks like they are.
[CUSTOMER][NEUTRAL] Yes. No, actually, no, it's, it's multiple CBT. The first one has two lines.
[AGENT][NEUTRAL] What is the
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the second one has also 3 lines.
[AGENT][NEUTRAL] What is the facility name?
[CUSTOMER][NEUTRAL] Memorial pathology Consultants.
[AGENT][NEUTRAL] Got it. OK.
[AGENT][NEUTRAL] The 14 6 13.
[AGENT][NEUTRAL] We received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And processed on [PII].
[AGENT][NEUTRAL] And that claim was denied as the outpatient benefit for the calendar year has been met.
[AGENT][NEUTRAL] And I can provide that claim number if you need it.
[CUSTOMER][NEUTRAL] So it had been met. OK. Yes, the claim number?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Claim number is 349.
[AGENT][NEUTRAL] 486 4.
[CUSTOMER][NEUTRAL] OK, uh, are, are we able to balance bill the patient for this if they were over their calendar year?
[AGENT][NEUTRAL] Mhm. So, we are not major medical.
[CUSTOMER][NEUTRAL] Ma
[AGENT][NEUTRAL] And we don't determine patient responsibility, that would be determined by the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me check this other data service for you.
[AGENT][NEUTRAL] For [PII].
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Bear with me just one second.
[AGENT][NEUTRAL] Same facility, correct?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just one second.
[AGENT][NEUTRAL] And that was the one for [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right.
[AGENT][NEGATIVE] And that claim we received on [PII] and processed on [PII], it was denied for the same reason. The outpatient benefit for the calendar year has been met.
[CUSTOMER][NEUTRAL] OK. And what's the claim number?
[AGENT][NEUTRAL] Claim number 3494866.
[CUSTOMER][NEUTRAL] OK. All right. Is there a reference number to our phone call?
[AGENT][NEUTRAL] It's gonna be my name and today's day, let me try that again. My name and today's date, and I spell my name, [PII] I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] OK, and what's the
[CUSTOMER][NEUTRAL] What's your initial of your last name, [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK. Thank you. Have a good day.
[AGENT][POSITIVE] My pleasure to help you with that claim status. Thank you for calling.