AccountId: 011433970860
ContactId: 44b1ceeb-6c8e-4e53-b8e9-921ef92f7df8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 313619 ms
Total Talk Time (AGENT): 140118 ms
Total Talk Time (CUSTOMER): 98291 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/44b1ceeb-6c8e-4e53-b8e9-921ef92f7df8_20250319T13:38_UTC.wav
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[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Thank you for calling APL. This is. May I help you?
[CUSTOMER][NEUTRAL] Yeah, hi. Yeah, hi, this is Ja[PII]alling from the provider office to check on the claims.
[AGENT][NEUTRAL] OK, I can verify claim status for you. And you say your name is Ja[PII]?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yes, J [PII].
[AGENT][NEUTRAL] [PII]K, and what is that policy number, please?
[CUSTOMER][NEUTRAL] 02498570.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yeah, it's 87[PII]irectly.
[AGENT][NEUTRAL] OK, thank you. And verify that patient's name, date of birth, please.
[CUSTOMER][NEUTRAL] Yeah, patient's name it's gonna be Da[PII]2[PII].
[AGENT][NEUTRAL] OK. Uh, thank you. And you say you're calling for claim status, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] 9 [PII]or $279 even.
[AGENT][NEUTRAL] OK, thank you. And do you have the balance after primary insurance has processed the claim?
[CUSTOMER][NEUTRAL] Yeah, it's $165.41. It was denied due to benefits maximum exceeded. I just need what kind of benefits maximum offering exceeded.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Before that, could you spell your name?
[AGENT][NEUTRAL] Sure, K [PII].
[AGENT][NEUTRAL] And you're calling from?
[CUSTOMER][NEUTRAL] No other office.
[AGENT][NEUTRAL] What's the name of the provider's office?
[CUSTOMER][NEUTRAL] Oh, it's gonna be.
[CUSTOMER][NEUTRAL] Medical University of Hospital Authority.
[AGENT][NEUTRAL] OK, and I apologize, Ja[PII]What was that balance again after primary?
[CUSTOMER][NEUTRAL] $165.41.
[AGENT][POSITIVE] OK, thank you, and give me one moment.
[AGENT][NEUTRAL] OK, and while I'm looking up claim information, just to let you know we do have an online service center where providers can check claim status as well as print out the EOB. That site is at se[PII].
[AGENT][NEUTRAL] 122.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, the claim process is the outpatient benefit max for that occurrence. The insured has a benefit max for outpatient and they've already met the max for that occurrence.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] stated that the claim was denied or not.
[CUSTOMER][NEUTRAL] I was then as outpatient as outpatient benefits, right?
[AGENT][NEUTRAL] Outpatient benefits have maxed for the occurrence.
[CUSTOMER][NEUTRAL] You stated that the claim was as patient as out outpatient benefits, right?
[AGENT][NEUTRAL] Yes, the outpatient benefit has maxed for the occurrence.
[CUSTOMER][POSITIVE] And it was exceeded, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And it was for the data source, right?
[AGENT][POSITIVE] For that occurrence, correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could be able to give when the last uh out of benefits was exceeded?
[AGENT][NEUTRAL] No, I can't give you that information.
[AGENT][NEUTRAL] Hey, Ja[PII]is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] You cannot able to provide that.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] OK. Uh, you cannot be able to give that information, right?
[AGENT][NEUTRAL] Correct. We cannot give that information.
[CUSTOMER][POSITIVE] I can able to appeal this.
[AGENT][NEUTRAL] Uh, you have up to 180 days from the time the claim was processed to submit an appeal. You must submit a letter stating the reason for the appeal.
[CUSTOMER][NEUTRAL] Please mailing address?
[AGENT][NEUTRAL] PO[PII].
[CUSTOMER][NEUTRAL] A mailing address.
[AGENT][NEUTRAL] 24[PII].
[CUSTOMER][POSITIVE] Yeah, got it.
[AGENT][NEUTRAL] OK, you asked for the mailing address, so you do have the mailing address for an appeal, correct?
[CUSTOMER][NEUTRAL] Yeah, it's 24[PII]OK, 73[PII].
[AGENT][NEUTRAL] Correct. Is there anything else I can assist you with today, Ja[PII]?
[CUSTOMER][NEUTRAL] And that.
[CUSTOMER][NEUTRAL] I'm filing limit for that.
[AGENT][NEUTRAL] You have 180 days from the time the claim was processed to submit an appeal, and you must submit a letter stating the reason for the appeal.
[CUSTOMER][NEUTRAL] 10 yeah.
[CUSTOMER][NEUTRAL] Could you the call reference number.
[AGENT][NEUTRAL] We don't give reference numbers. If you like, you may use my name at today's date.
[CUSTOMER][NEUTRAL] KK, right?
[AGENT][NEUTRAL] Correct, last initial Q.
[CUSTOMER][POSITIVE] Thank you.