AccountId: 011433970860
ContactId: 4cb5b8a8-5fee-4c2f-8dcd-5b5aa1ef7461
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 251070 ms
Total Talk Time (AGENT): 117194 ms
Total Talk Time (CUSTOMER): 68553 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/4cb5b8a8-5fee-4c2f-8dcd-5b5aa1ef7461_20250107T20:09_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] from the provider's office. Please, can you assist me with the claim?
[AGENT][NEUTRAL] You have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Yes, only one.
[AGENT][POSITIVE] Yes, ma'am. I can help you. And what was your name again?
[CUSTOMER][NEUTRAL] Uh, [PII]
[AGENT][NEUTRAL] Thank you, and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII]. And that's a direct line?
[AGENT][NEUTRAL] Thank you. And the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] 02449815.
[AGENT][NEUTRAL] OK thank you one moment please.
[CUSTOMER][NEUTRAL] Mhm OK.
[AGENT][NEUTRAL] And any information that I provide for you today, [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] and the date of birth, [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] And the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] [PII] with the total charge.
[CUSTOMER][NEUTRAL] That's going to be.
[CUSTOMER][NEUTRAL] $140 even.
[AGENT][NEUTRAL] 140. Is that correct?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK, so this claim was received on [PII]. It was processed on [PII].
[AGENT][NEUTRAL] The claim number is 353-772-8.
[AGENT][NEUTRAL] This claim was denied and the reason for the denial, Cheryl states outpatient benefit.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] For this calendar year has been met.
[CUSTOMER][NEGATIVE] So there is no coverage.
[CUSTOMER][NEUTRAL] On the state of service?
[AGENT][NEUTRAL] That is correct. As I the comment states, the reason for the denial is outpatient benefit for this calendar year has been met.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] So, can you please tell me the policy effective date and the termination date?
[AGENT][NEUTRAL] The effective date is [PII] and it is still current.
[AGENT][NEUTRAL] It's active.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Uh, and finally,
[AGENT][NEUTRAL] And if you need a copy of that, I'm sorry. I was gonna say if you need a copy of the explanation of benefits, you may print that from our portal by going to secured.
[CUSTOMER][NEUTRAL] Mhm, yeah, yeah.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][POSITIVE] Thank you so very much.
[AGENT][POSITIVE] You are certainly very welcome. And is there anything else that I can help you with this afternoon?
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Please, can you provide me the call reference number?
[AGENT][NEUTRAL] Yes ma'am, you would use my name along with today's date.
[CUSTOMER][NEUTRAL] Can you please spell it?
[AGENT][NEUTRAL] [PII] and the first initial to my last name [PII] is [PII].
[CUSTOMER][POSITIVE] Uh yeah, OK then. Uh, thank you so very much for assisting me today. Have a great day. Goodbye and take care.
[AGENT][POSITIVE] You, yes ma'am. You too. Yes, ma'am, you too, and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye-bye.