AccountId: 011433970860
ContactId: 3dd872ed-b09d-48dd-8207-9d8c5b5fafec
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 311839 ms
Total Talk Time (AGENT): 142306 ms
Total Talk Time (CUSTOMER): 78771 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/3dd872ed-b09d-48dd-8207-9d8c5b5fafec_20250528T20:08_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Good afternoon thank you for
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from Ocean Springs Urgent Care, and I'm trying to get um an explanation about a denial we received.
[AGENT][NEUTRAL] OK, [PII], so you said that you're needing to get information on a denied claim for a member, is that correct? Yes, ma'am, I can help you with that. And [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] Um, I have.
[CUSTOMER][NEUTRAL] Hm I have D 46002254.
[AGENT][NEUTRAL] OK, now, thank you, but [PII], that is not an APL policy number, that is a 90 degree benefit number. Were you trying to reach 90 degree benefits or APL?
[CUSTOMER][NEUTRAL] No, I have, I have an APL denial and OK, the policy number is different on here it's um.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] It is. Mhm.
[CUSTOMER][NEUTRAL] Yeah, 02587071.
[AGENT][NEUTRAL] OK, thank you one moment. So did you receive the explanation of benefits from APL, [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And any information that I do provide for you will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's for [PII].
[CUSTOMER][NEUTRAL] Uh, date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her place?
[CUSTOMER][NEUTRAL] It's 130 $2025364.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Thank you. And the claim number?
[CUSTOMER][NEUTRAL] 356343-1.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] It's just taking a moment to pull the information. OK, so on this claim.
[AGENT][NEUTRAL] There was a $50 benefit issued.
[CUSTOMER][NEUTRAL] There was a $50 bill.
[AGENT][NEUTRAL] On check number 202.
[AGENT][NEUTRAL] 8 911.
[AGENT][NEUTRAL] And the
[AGENT][NEUTRAL] Other and that was paid on the 99204 and the other three codes were denied for the same reason stating the maximum benefit payable for this state of service has been met. This is a, this is not major medical insurance, it's a hospital.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Limited benefit plan. It's also indemnity limited benefit plan.
[AGENT][NEUTRAL] So with the $50 payment.
[AGENT][NEUTRAL] For the visit.
[AGENT][NEUTRAL] With that check, the maximum benefit payable for this data service has been met.
[CUSTOMER][NEUTRAL] With that
[CUSTOMER][NEUTRAL] OK, so, um, max max benefit has been paid. It's a limited benefit plan and so the patient's responsible for the balance.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And we do not determine patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And your name again is [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] [PII], yes ma'am, and you would use my name along with today's date as your call reference number and then for future reference if you ever need an explanation of benefits on one of our claims once it's been processed, you should be able to print that. Gina, if you go to our portal which is located at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right well thank you so much for your help.
[AGENT][POSITIVE] Well, you're very welcome. So is there anything else that I can help you with?
[CUSTOMER][NEUTRAL] No, that's all.
[AGENT][POSITIVE] OK, well then thank you for calling APL and I hope you have a nice rest of your day.
[CUSTOMER][POSITIVE] Same to you thank you so much bye bye.
[AGENT][POSITIVE] Yes ma'am, and thank you too. Bye-bye.