AccountId: 011433970860
ContactId: 44dcede1-3ea4-4f0c-b5ec-d7ff0bcb0083
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 359339 ms
Total Talk Time (AGENT): 123214 ms
Total Talk Time (CUSTOMER): 114607 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/44dcede1-3ea4-4f0c-b5ec-d7ff0bcb0083_20250107T16:21_UTC.wav
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[AGENT][POSITIVE] Good morning thank you for calling APL this is [PII]. How may I assist you?
[CUSTOMER][POSITIVE] Good morning thank you for calling.
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling from provider office. Just I need the claim status.
[AGENT][NEUTRAL] Sure, I can assist you with claim status, Ms. [PII], and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, the callback number is [PII], no extension direct line.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] May I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, that is 1067765.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Can I have your once again your name, please?
[AGENT][NEUTRAL] Sure. My name is [PII]. That's [PII] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, and may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah, the patient date of birth is [PII].
[AGENT][NEUTRAL] OK. What's the name?
[CUSTOMER][NEUTRAL] The patient name is [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the date of service and the amount of the claims?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII] and total bill amount is $1,826 even.
[AGENT][NEUTRAL] OK, thank you. Let me see if I can find this claim for you and for future you can check claim status online through our website at [PII], and that's just optional. And let's see here we go. Let me pull this EO.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Oh my [PII]
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I'm still waiting on the.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] All right, so it looks like we received the claim on [PII] and we processed the claim on [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the claim was denied. Um, the reason for this denial is that let's see.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, it looks like the maximum amount payable for this occurrence has been met. So the benefits has been exhausted.
[CUSTOMER][NEUTRAL] Like.
[CUSTOMER][NEUTRAL] I've been
[CUSTOMER][NEGATIVE] exhausted.
[CUSTOMER][NEUTRAL] The maximum amount has already been paid?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And what is the claim number?
[AGENT][NEUTRAL] My number is 349-4200.
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] 2
[CUSTOMER][NEUTRAL] And can I, uh, can we appeal this one?
[AGENT][NEUTRAL] You have 180 days from the decision date.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] To submit any appeals.
[CUSTOMER][NEUTRAL] 180 days. OK.
[CUSTOMER][NEUTRAL] The offer is 180 days.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] So we cannot appeal that one, that is correct.
[AGENT][NEUTRAL] No, it was denied on [PII]. So you have 180 days from that date, [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, it is there. What is the address?
[AGENT][NEUTRAL] OK, the PO address is [PII].
[CUSTOMER][NEUTRAL] In [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] My ZIP code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, thank you. And uh
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What is the conference number for this call?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will. You need the spelling of my name or any other information?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, thank you so much. Have a nice day. Bye. Take care.
[AGENT][POSITIVE] You're welcome. You as well. Thank you for calling ATM. Bye-bye.
[CUSTOMER][NEUTRAL] OK.