AccountId: 011433970860
ContactId: 4c2d0e89-acb7-46e0-aa78-40daeedd790d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 310109 ms
Total Talk Time (AGENT): 95559 ms
Total Talk Time (CUSTOMER): 99522 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/4c2d0e89-acb7-46e0-aa78-40daeedd790d_20250514T12:30_UTC.wav
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[AGENT][NEUTRAL] 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 check on a claim status. How are you doing today, [PII]?
[AGENT][POSITIVE] I'm good, [PII]. Thank you for asking. How are you?
[CUSTOMER][POSITIVE] I'm doing good, thank you for asking. I'd like to check on my claim status. Could you please help me with that?
[AGENT][POSITIVE] Happy to check on a claim for you today. May I please have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, one moment.
[CUSTOMER][NEUTRAL] And the patient's policy number?
[CUSTOMER][NEUTRAL] Yes. The policy ID is 02505608.
[AGENT][NEUTRAL] Thank you. And may I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you and then date of service?
[CUSTOMER][NEUTRAL] The date of service here is [PII].
[AGENT][NEUTRAL] In the build out?
[CUSTOMER][NEUTRAL] The total bill amount here is $4,389.14.
[AGENT][NEUTRAL] All right, thank you, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so it looks like we did receive a claim for the state of service. Uh, the claim was received [PII].
[AGENT][NEUTRAL] Or I'm sorry, [PII].
[AGENT][NEUTRAL] Claim was processed and denied on [PII]. The maximum benefit for the state of service had already been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry, could you please provide me the claim denied reason?
[AGENT][POSITIVE] Maximum benefit for the state of service has been met.
[CUSTOMER][NEUTRAL] OK. So the maximum benefits have been exhausted.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. Uh, may I know whether the benefits have been used as per dollars or visits?
[AGENT][NEUTRAL] It was per dollars.
[CUSTOMER][NEUTRAL] Now, may I know the number of dollars allowed for the patient?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] The outpatient benefit max for it looks like an ER visit was a benefit amount of $50 and that had already been exhausted.
[CUSTOMER][NEUTRAL] OK, $50.
[CUSTOMER][NEGATIVE] It's been exhausted.
[CUSTOMER][NEUTRAL] It has been fully met by the patient, right?
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] Including this claim, right?
[CUSTOMER][NEUTRAL] Or excluding the screen?
[AGENT][NEUTRAL] Excluding this claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So the total patient responsibility is the entire charge amount, right?
[AGENT][NEUTRAL] We're not able to advise on patient responsibility that's up to the facility or the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] SC05.
[CUSTOMER][NEUTRAL] So here the total amount is denied, right?
[AGENT][POSITIVE] Correct, the entire.
[CUSTOMER][NEUTRAL] $4,389.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Could you please provide me the claim number?
[AGENT][NEUTRAL] Uh, claim number is 3554874.
[CUSTOMER][NEUTRAL] So much for that one. Could you please provide me the call reference number for this call?
[AGENT][NEUTRAL] Call reference is my name with my last initial and then today's date. My name again is [PII], that's [PII] Last initial is [PII], and today's date.
[CUSTOMER][POSITIVE] Anyways, thank you so much for your assistance. Have a great day. Bye-bye.
[AGENT][NEUTRAL] You too. Bye bye.