AccountId: 011433970860
ContactId: 4d486432-667e-43e8-9311-f9f1ca6bdea9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 439350 ms
Total Talk Time (AGENT): 106548 ms
Total Talk Time (CUSTOMER): 219804 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/4d486432-667e-43e8-9311-f9f1ca6bdea9_20250130T20:00_UTC.wav
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[AGENT][NEUTRAL] For calling APL, my name is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] [PII], my name is [PII] calling from provider's office, checking on claim status and how are you doing today?
[AGENT][POSITIVE] I'm good. I'll be happy to assist with claim status today, [PII], if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] [PII]. Could you please spell your name? It's [PII]
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Policy number?
[CUSTOMER][NEUTRAL] 01896036 Mary Lima 8.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Name under [PII].
[CUSTOMER][NEUTRAL] [PII], it's [PII] [PII].
[AGENT][NEUTRAL] And the date of service?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] For $1,362 even.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, it looks as though we received that claim twice. thank you for that information.
[CUSTOMER][NEUTRAL] I should have.
[AGENT][NEGATIVE] Uh, the first time the claim denied because the outpatient had been maxed out for the year, the second time it denied as a duplicate.
[CUSTOMER][NEUTRAL] OK, help me out with the claim number. I'm on your portal itself. I'm just checking for the copy of EOB. Help me out with the claim number.
[AGENT][NEUTRAL] 3506455
[CUSTOMER][NEUTRAL] [PII] would be the patient's name and date of birth, [PII].
[CUSTOMER][NEUTRAL] 8.
[CUSTOMER][NEUTRAL] Yes, one moment.
[CUSTOMER][NEUTRAL] When did you receive the claim?
[AGENT][NEUTRAL] Claim was received on [PII]. Claim denied on [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], maximum dollar amount has been made by the patient or else maximum.
[CUSTOMER][NEUTRAL] Visits has been exhausted.
[AGENT][NEGATIVE] The maximum benefit was exhausted.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK, I can understand that, but I'm asking you maximum dollar amount has been exhausted or else visits has been exhausted.
[AGENT][NEUTRAL] The dollar amount.
[CUSTOMER][NEUTRAL] Mhm. What was the dollar amount?
[AGENT][NEUTRAL] 500 per year.
[CUSTOMER][NEUTRAL] Actually.
[CUSTOMER][NEUTRAL] And could you please help me out? When was the last service made by this patient on, as you stated the maximum dollar amount has been met right? Could you please help me out with that?
[AGENT][NEGATIVE] I don't understand the question.
[CUSTOMER][NEUTRAL] Help me out with the last date of service for this made by this patient on.
[CUSTOMER][NEUTRAL] As this state of claim was denied on [PII] as maximum benefits has been exhausted, right? But my question is that when my question is when was the last service met by this patient?
[AGENT][NEUTRAL] I don't you said when was the last service?
[CUSTOMER][NEUTRAL] No, you said that the maximum benefits exhausted by this patient, right? $500 per year has been exhausted. But my question is,
[CUSTOMER][NEUTRAL] But already has been processed and help me out when was the last service met by this patient?
[CUSTOMER][NEUTRAL] Date of service.
[AGENT][NEUTRAL] Do you wanna know?
[AGENT][NEUTRAL] When, what day they maxed out their benefit? Is that what you're trying to ask me?
[CUSTOMER][NEUTRAL] Previously, yes, uh-huh. But you said that the claim was denied on [PII], [PII]. It's OK, completely. But I'm asking you, when was the last service met by this patient? The calendar year would be 500, right?
[AGENT][NEUTRAL] So you're asking me what day did we process the claim that paid all of the benefits up that he used all of the benefits is that, that's OK, OK, you, you weren't asking that. That's not what you were saying, that's why I misunderstood, but the day that um he maxed out his benefit was [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, uh huh.
[CUSTOMER][NEUTRAL] OK, sorry.
[AGENT][NEUTRAL] That's the day we process the claim, right, that's the day we processed and paid on a claim from a previous provider that used all his benefits.
[CUSTOMER][NEUTRAL] [PII], right?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Call reference number would be [PII] First initial is your last name?
[AGENT][POSITIVE] That's correct. Was there anything else I could assist with today?
[CUSTOMER][NEUTRAL] One more patient for the day. I'm asking you first initial to your last name.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] idea.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You know for the next and last ID number, [PII]?
[AGENT][POSITIVE] OK, I'm ready.
[CUSTOMER][POSITIVE] Yes, thank you.
[CUSTOMER][NEUTRAL] And I have downloaded the copy of you from your portal. Thank you for your claim number.
[CUSTOMER][NEUTRAL] Mhm. And
[CUSTOMER][NEUTRAL] The ID number which is like starting from.
[CUSTOMER][NEUTRAL] 01780690 [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Patient's name?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Attero with data was [PII].
[CUSTOMER][NEUTRAL] It's
[AGENT][NEUTRAL] Data service?
[CUSTOMER][NEUTRAL] [PII] my payment I have.
[CUSTOMER][NEUTRAL] Date of service, [PII] for $348 even.
[AGENT][NEUTRAL] Claims or not because office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] Help me out with the claim number.
[AGENT][NEUTRAL] Claim number is 351-9094.
[CUSTOMER][NEUTRAL] One moment. Help me on what of a plan does the patient have?
[AGENT][NEUTRAL] This is a gap policy.
[CUSTOMER][NEUTRAL] Supplement gap policy.
[CUSTOMER][NEUTRAL] I think
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Well which you provided. And uh when did you deny the claim on?
[AGENT][NEUTRAL] Claim was denied on [PII]. Claim was received on [PII].
[CUSTOMER][POSITIVE] [PII]. Thank you. Bye-bye. Take care.
[AGENT][POSITIVE] Thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] OK.