AccountId: 011433970860
ContactId: 40232734-c591-49ae-b3c9-d05ae2be5f57
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 598760 ms
Total Talk Time (AGENT): 233853 ms
Total Talk Time (CUSTOMER): 117017 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/23/40232734-c591-49ae-b3c9-d05ae2be5f57_20250623T17:43_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider office to discuss on the claims.
[AGENT][NEUTRAL] OK, [PII], you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII]. Direct line.
[AGENT][NEUTRAL] Thank you. And how many, OK, [PII], thank you. And how many clients do you have to check status on?
[CUSTOMER][NEUTRAL] 2 claims.
[AGENT][NEUTRAL] For the same patient or different patients?
[CUSTOMER][NEUTRAL] One is for different, 2 are for same.
[AGENT][NEUTRAL] So you have 2 dates of service for 1 member and 1 date of service for another. Is that correct?
[CUSTOMER][NEUTRAL] Uh, yeah, right.
[AGENT][NEUTRAL] OK, so yes, ma'am. So I can help you with all of that, and [PII], you will use my name that I gave you along with today's date as each of your call reference numbers. Also any information.
[CUSTOMER][NEUTRAL] Yeah, could you please repeat your name? I'm sorry to interrupt, but I missed your name. Could you repeat that for me?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And you're welcome, and any information that is provided on any of the claims will be a verification of benefits and not a guarantee of payment. And lastly, [PII], if we do have the claims on file and you need a copy of the explanation of benefits, once I provide you the claim numbers, you should be able to use those to print the explanation from our, or excuse me, the explanation of benefits from our portal and the website that you would go to for that is secured.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is your first patient's policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 02267455.
[AGENT][NEUTRAL] OK, now on this number is this the one that has 1 or 2 dates of service?
[CUSTOMER][NEUTRAL] One
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Member's name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] What is the date of service and total bill amount for her please, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Amount is, yeah.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Amount is $2,187 even.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] OK, so I do show that this claim was received. It was received on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] The claim number is 359-8401.
[AGENT][NEGATIVE] This claim was denied.
[AGENT][NEUTRAL] And the remark for the denial states outpatient benefit for this calendar year has been met.
[CUSTOMER][NEUTRAL] OK. I mean, how many uh outpatient uh visits are allowed?
[AGENT][NEUTRAL] This is a this plan is based on a dollar amount for outpatient and the outpatient calendar year maximum is $6000 per covered insured.
[AGENT][NEUTRAL] Her calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So far, you'll be, uh, can, could
[AGENT][NEUTRAL] With no deductible.
[CUSTOMER][NEUTRAL] OK. Can you send us the EOB?
[AGENT][NEUTRAL] OK, I gave you the website, [PII], so that you can print it yourself.
[AGENT][NEUTRAL] Did you take down the website that I gave you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, no, I didn't take it. Uh, so is it self-registration?
[AGENT][NEUTRAL] It is, yes, ma'am.
[CUSTOMER][POSITIVE] OK. Can I have it once again? I'm so sorry.
[AGENT][POSITIVE] Secured
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] You're welcome. And did you need any other information on this number?
[CUSTOMER][NEUTRAL] So yeah.
[CUSTOMER][NEUTRAL] Uh, no, that's all for this member.
[AGENT][NEUTRAL] OK, and this one you did say only had one data service, correct?
[CUSTOMER][NEUTRAL] Mm, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is um your next patient's policy number?
[CUSTOMER][NEUTRAL] It is 02150874.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the first day of service and total bill amount for him, please?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] Bill amount is $201 even.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so this claim was received on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] The claim number is 3595078.
[AGENT][NEUTRAL] And the remark on this claim states that benefits have been applied.
[AGENT][NEUTRAL] She's a $1000 calendar year deductible.
[AGENT][NEUTRAL] So on this claim, there was $44.14 applied towards the $1000 calendar year deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much, [PII]. That's all for that date of service and I'm ready with the next date of service for same member.
[AGENT][NEUTRAL] OK, and what is that data service and total bill amount?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] $263 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so this has the same code as the last one that benefits were applied to the calendar year deductible and the amount that was applied on this claim was $163.06.
[CUSTOMER][NEUTRAL] OK. What is the claim number?
[AGENT][NEUTRAL] I'm so sorry. It is 359-536-7.
[CUSTOMER][NEUTRAL] In the process date?
[AGENT][NEUTRAL] 429.
[CUSTOMER][POSITIVE] OK. OK. So, yeah, that's all for today and have a good day ahead. Bye.
[AGENT][POSITIVE] OK, [PII]. Well, if that's all I can help you with, thank you again for calling APL and I hope you have a nice day as well.
[AGENT][NEUTRAL] Bye bye.