AccountId: 011433970860
ContactId: 40e618b6-d2a0-404a-b999-17c7420c399a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 319799 ms
Total Talk Time (AGENT): 137819 ms
Total Talk Time (CUSTOMER): 96821 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/40e618b6-d2a0-404a-b999-17c7420c399a_20250311T17:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi, [PII], I'm [PII], and I'm calling from provider's office to check on the status of a claim.
[AGENT][NEUTRAL] Sure, I could check in a claim for you. I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] [PII], OK, uh, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, your callback number is [PII] and it's a direct line.
[AGENT][NEUTRAL] OK, thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, policy number for the patient is 02446531.
[AGENT][NEUTRAL] OK and uh what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] The member's name is [PII] and date of birth for him is [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Perfect, thank you for verifying that and what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Uh, date of service is [PII].
[AGENT][NEUTRAL] [PII] and then uh do you have the bill amount?
[CUSTOMER][NEUTRAL] Oh yeah, it's for $4,117 even.
[AGENT][POSITIVE] Got it OK thank you one moment please.
[CUSTOMER][POSITIVE] Yeah, sure, thank you.
[AGENT][NEUTRAL] OK, [PII], was that the amount before or after uh major medical paid?
[CUSTOMER][NEUTRAL] Uh, no, it's far before. The Medicare has been, uh, BCBS has been paid with $9901.18 and the leftover of $307.39 was being transferred. So the total amount is $4,117.
[AGENT][NEUTRAL] OK, all right, thank you. One moment.
[CUSTOMER][POSITIVE] Yeah, sure. Thank you.
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] OK, so I did find this claim, [PII]. We were unable to pay a benefit as their maximum benefit payable for the date of service had been met.
[CUSTOMER][NEUTRAL] Uh, may I know, or is that exhausted with the amount or uh dollars or of the seats?
[AGENT][NEUTRAL] Uh, it's the dollar amount, so their outpatient benefit pays on a per calendar day basis, so it pays up to $500 per calendar day, and they have had a few, uh, claims prior to this one on the same date that paid that $500.
[CUSTOMER][NEUTRAL] May I know the date that it got paid for the dollar amount of $500?
[AGENT][NEUTRAL] It was the same.
[AGENT][NEUTRAL] It's the same date of service.
[CUSTOMER][NEUTRAL] Oh, same date of service. Thank you so much. Uh, so it's been the same date of service for the physician claim that you got paid?
[AGENT][NEUTRAL] Right, of course.
[AGENT][NEUTRAL] Yes, as the that's how this policy pays the outpatient benefit as a maximum on a per calendar day basis.
[CUSTOMER][POSITIVE] Oh thank you so much. Uh thank you. And for my documentation purpose, can I get a claim, I mean the appeal mailing address and also the timely filing for an appeal?
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Yes, um, OK, so for timely, um, for appeals are gonna be 180 days, uh, from the process date, so let me get that for you. Let me see when this was processed.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Of course one moment.
[AGENT][NEUTRAL] OK, uh, so this claims process date was [PII], so unfortunately it is going to be outside of that, uh, time frame for appeals.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh, thank you. And can I also get the claim number?
[AGENT][NEUTRAL] Of course that is 344-7.
[AGENT][NEUTRAL] excuse me, 538.
[CUSTOMER][NEUTRAL] Oh thank you. Can I also get an appeal mailing address?
[AGENT][NEUTRAL] Mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Thank you. Can I get the spelling of your name with the call reference, please?
[AGENT][NEUTRAL] Sure, reference number would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII] Last initial is [PII] And was there anything else I can help you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh, no, I'm done. Thank you much for assisting. Have a good day. Bye-bye and take care. Stay safe.
[AGENT][POSITIVE] Of course, thanks for calling APL you too bye bye.