AccountId: 011433970860
ContactId: 4da59b98-344a-4f71-bd83-6d1ea8125617
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 284339 ms
Total Talk Time (AGENT): 132630 ms
Total Talk Time (CUSTOMER): 68708 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/4da59b98-344a-4f71-bd83-6d1ea8125617_20250304T16:16_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], and first name is, my last name is [PII]. Actually, I'm here uh to know the claim status.
[AGENT][NEUTRAL] OK, [PII], you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] 02064142.
[AGENT][POSITIVE] OK, thank you one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] And [PII], if you need the first initial to my last name, it is also [PII]
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And any information that I provide for you, [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] Uh, first name is [PII], last name is [PII]. The date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount, please.
[CUSTOMER][NEUTRAL] Data service is [PII]. The total bill amount is uh
[CUSTOMER][NEUTRAL] $21,195.61.
[AGENT][NEUTRAL] OK, $21,195.61. Is that correct?
[CUSTOMER][POSITIVE] Yes, it is correct.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so this claim was received.
[AGENT][NEUTRAL] And the received date was [PII].
[AGENT][NEUTRAL] Processed and denied on [PII].
[CUSTOMER][NEUTRAL] What is the denial reason?
[AGENT][NEUTRAL] The claim number is 352.
[AGENT][NEUTRAL] 073 9.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome. And the reason for the denial on this claim?
[AGENT][NEUTRAL] the excuse me, the maximum amount payable for this occurrence has been met. Per occurrence means treatment for the same or related condition unless separated by a period of 90 days. Treatment for the same or related conditions separated by 90 days or an unrelated condition will be considered a new per occurrence.
[CUSTOMER][NEUTRAL] OK. Uh, what is the maximum amount, uh, the, at the, that was reached?
[AGENT][NEUTRAL] OK, the maximum per occurrence benefit on this policy for covered services is $500.
[CUSTOMER][NEUTRAL] And when it was reached.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 718, 2024.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Uh, so now it is patient responsibility, correct?
[AGENT][NEUTRAL] We, we do not determine patient responsibility, that would be up to the provider.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK. Would you please help me with a good call reference number?
[AGENT][NEUTRAL] Yes sir, but first, if you need a copy of this primary insurance, I'm sorry, if you need a copy of APO's explanation of benefits, [PII], you can print that by going to our portal which is located at [PII].
[AGENT][NEUTRAL] And for the reference number, you would use my name along with today's date.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] OK, thank you. Thank you for your time.
[AGENT][POSITIVE] You're welcome. Yes, so you're very welcome. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] No, I'm done with my concern. Thank you.
[AGENT][POSITIVE] OK, well then thank you again for calling APL. I hope you have a.