AccountId: 011433970860
ContactId: 4d00e0ff-3dd5-475f-9cf5-4f2e3c96d374
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 257079 ms
Total Talk Time (AGENT): 90175 ms
Total Talk Time (CUSTOMER): 114925 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/4d00e0ff-3dd5-475f-9cf5-4f2e3c96d374_20250620T15:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII].
[AGENT][NEUTRAL] How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from the provider office to check the claim status.
[AGENT][NEUTRAL] OK, I could check on a claim for you. [PII]. Can I get a call back number from you first in case we're disconnected please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure. The callback number is [PII]. There is no extension. It is a direct line.
[AGENT][NEUTRAL] OK, thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Sorry, I don't have it. Yes, yes, I have it. Sorry for it. It was 025.
[CUSTOMER][NEUTRAL] 652-227
[AGENT][NEUTRAL] OK, and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The last name is [PII], and the first name is [PII]. And the date of birth is [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that and what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Sure. The date of service of the claim is, it was [PII]. To the total charges, $3,045 and even.
[AGENT][NEUTRAL] OK, and then uh what was the tax ID for this uh provider please?
[CUSTOMER][NEUTRAL] Sure. The tax ID is, just allow me a moment, I'm checking on it.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It was [PII].
[CUSTOMER][NEUTRAL] Sorry, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you so much for verifying that one moment please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK so we did receive this claim [PII] we were unable to pay a benefit as their outpatient benefit for the calendar year had been met.
[CUSTOMER][NEUTRAL] OK, means it was denied.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] They had met their maximum outpatient benefit amount.
[CUSTOMER][NEUTRAL] OK. The claim is
[CUSTOMER][NEUTRAL] OK. It was denied uh for the maximum benefits exhausted, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, for what, uh, like how many patients, like how many outpatient visits are there for the member policy?
[AGENT][NEUTRAL] It wasn't the visits, it was the dollar amount, uh, for the calendar year that had been met.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That maximum that's uh $1500 per calendar year.
[CUSTOMER][NEUTRAL] Uh, OK.
[CUSTOMER][NEUTRAL] OK. That already it was paid, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] Just allow me a moment.
[CUSTOMER][NEUTRAL] Can you please help me out when it was paid and uh with, with what claim and which claim it was paid and the claim ID?
[AGENT][NEGATIVE] Um, I'm I am unable to give that information as that is from a different provider.
[CUSTOMER][NEUTRAL] OK. Can you please fax the UB?
[AGENT][NEUTRAL] Sure, what was that fax number for you?
[CUSTOMER][NEUTRAL] It was [PII].
[AGENT][NEUTRAL] OK, I'm going to read that back to make sure I heard that correctly. That was [PII].
[CUSTOMER][NEUTRAL] And for this, can you please help me out with?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure. And can you please help me out with the claim number?
[AGENT][NEUTRAL] Yes, that is 361-342-6.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] And call reference number?
[AGENT][NEUTRAL] Reference number would be my first name, last initial, and today's date. Uh so my name is spelled [PII] A R A. last initial [PII] Was there anything else I could help you with?
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][POSITIVE] OK. Thank you so much for your assistance and have a great day. Bye-bye.
[AGENT][POSITIVE] Of course, thanks for calling A PL you too.