AccountId: 011433970860
ContactId: 41d117e1-0f53-46b1-9fc1-71eb56911d2c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 443660 ms
Total Talk Time (AGENT): 170354 ms
Total Talk Time (CUSTOMER): 130059 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/41d117e1-0f53-46b1-9fc1-71eb56911d2c_20250424T14:28_UTC.wav
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[AGENT][POSITIVE] Good Morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider office for checking claim status.
[AGENT][NEUTRAL] OK, could you spell your name for me, please?
[CUSTOMER][NEUTRAL] Yeah, sure. Uh, [PII], and last name first initial is [PII].
[AGENT][NEUTRAL] OK, [PII], and you said thank you and you said you're needing to check claim status, is that correct?
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with [PII]. What is your callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. And how many clients do you have to check status on?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] How many?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] How many claims do you have to check status on?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How many clients it's uh one patient.
[CUSTOMER][NEUTRAL] One patient, one client.
[AGENT][NEUTRAL] Yes. OK. And what is the member's policy number, please?
[CUSTOMER][NEUTRAL] Yeah, the member ID is F as in Frank, S as in um OK FSOH 37158923.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you, [PII], but that is not a policy number for our company. What company were you trying to reach?
[CUSTOMER][NEUTRAL] OK, one moment please, I check. OK, OK, uh, I'm checking for BCB, sorry, uh, the APL member ID is 02042067 M as in Mike L as in Lima number 8.
[AGENT][POSITIVE] OK, thank you. Give me a couple of moments please to get the member's information pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and any information, [PII], that I do provide today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Not sure, um.
[CUSTOMER][NEUTRAL] Patient name is [PII].
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Her, yes, and I, and I need her date of birth.
[CUSTOMER][NEUTRAL] Date of birth, uh [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount please.
[CUSTOMER][NEUTRAL] Sure, mm, my data service is [PII] and total charge amount is $470 even.
[AGENT][NEUTRAL] 470.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And you said 327 of 2024, is that correct?
[CUSTOMER][NEUTRAL] Yes, data service is 327-2024.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so it appears this claim was received one moment.
[AGENT][NEUTRAL] This claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was processed and denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3484358.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the reason for the denial states the maximum benefit payable for this date of service has been met.
[CUSTOMER][POSITIVE] Maximum benefits has been met.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEGATIVE] I received the UP of client services lack information.
[AGENT][NEUTRAL] And if you
[AGENT][NEUTRAL] OK, the, the remark on the claim is exactly and the denial from APL reads exactly as I gave what I just read to you the maximum benefit payable for this state of service has been met.
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] And if you need a copy of that explanation of benefits, Cody, you may print it now that you have the claim number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] By going to our portal.
[AGENT][NEUTRAL] Which is located at [PII].
[CUSTOMER][NEUTRAL] OK. May I know, um,
[CUSTOMER][NEUTRAL] OK. May this call put on hold for a moment?
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah thank you so much for uh hold and.
[CUSTOMER][NEUTRAL] May I know how many units are allowed?
[AGENT][NEUTRAL] The maximum benefit amount for covered outpatient services per calendar day is $500 and that was processed on a claim that was received prior to your claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, is there any benefits patients have?
[AGENT][NEUTRAL] I just I just read you the remark that states the maximum benefit payable for this state of service has been met.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. May I know your good name, please?
[AGENT][NEUTRAL] Again, my name is [PII].
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] First initial to my last name is [PII], and you would use my name along with today's date [PII] as your call reference number.
[CUSTOMER][POSITIVE] OK, perfect, thanks so much for giving details and have a great day bye bye.
[AGENT][POSITIVE] Oh, you're welcome.
[AGENT][POSITIVE] Yes sir you too if that's all I can help you with, thank you again for calling APL. Have a wonderful day as well.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Bye bye.