AccountId: 011433970860
ContactId: 4dfbfe08-f77e-4dc2-8748-6e2bd2bc9919
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 784739 ms
Total Talk Time (AGENT): 160973 ms
Total Talk Time (CUSTOMER): 145790 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/4dfbfe08-f77e-4dc2-8748-6e2bd2bc9919_20250219T17:17_UTC.wav
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[AGENT][POSITIVE] Good Morning. Thank you for calling APL. This is So. How may I assist you?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes, hi, my name is [PII] calling on behalf of provider's office to check on the general claim information.
[AGENT][NEUTRAL] OK, sure. I can assist you with claims. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And may I have the name you're calling from?
[CUSTOMER][NEUTRAL] Uh, Health First CHP.
[AGENT][NEUTRAL] OK, thank you. And what is the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] D as in Delta 42005319.
[AGENT][NEUTRAL] Do you see a policy certificate number? It's gonna start with a 0 followed by 7 digits.
[CUSTOMER][NEUTRAL] Uh, sorry?
[AGENT][NEUTRAL] Um, that the number is not our number, Miss [PII]. Uh, do you see a policy certificate number? It's gonna start with the 0 followed by 7 digits.
[CUSTOMER][NEUTRAL] Uh, let me check one moment please.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK. What's the spelling of the last name?
[CUSTOMER][NEUTRAL] Mm, it's [PII], [PII].
[AGENT][NEUTRAL] OK, and what's the spelling of the first name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] You said [PII], um, what's the next, is it [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] See
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] So it's [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. One moment.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What's his date of birth?
[CUSTOMER][NEUTRAL] The date of birth is on [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] I think it's gonna be.
[AGENT][NEUTRAL] OK, perfect. Alright, and what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yes, the rate of service is on [PII] with a valid amount of $170 even.
[AGENT][POSITIVE] Mm thank you.
[AGENT][NEUTRAL] OK, let me pull this EOB, OK. Do you mind holding for me?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] One moment. Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding and being patient for Ms. [PII]. Yeah, I have uh the claim um pulled up and it looks like uh the claim was denied. It was processed on [PII] indicating that the calendar, your maximum for outpatient office visit has been exhausted.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. May I know the claim receipt date?
[AGENT][NEUTRAL] Um, let me get that for you. That's not on the EOV.
[AGENT][NEUTRAL] 616.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, it was received on let's see.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] [PII], process [PII].
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK. So the claim has been denied for maximum benefit exhausted based on the office visit.
[AGENT][POSITIVE] Yes, correct. Mhm, yes.
[CUSTOMER][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So, uh, may I know the
[CUSTOMER][NEUTRAL] And will allowed office visit for this number.
[AGENT][NEUTRAL] Mhm. Sure, let me get that for you.
[AGENT][NEUTRAL] And this is not a guarantee of payment, just a verification of coverage. We cover $50 per visit maximum of 4 visits per covered person per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For visits.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, so it's already exceeded. Am I correct?
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Do you have the exits information like when was the last visit met?
[AGENT][NEUTRAL] Uh, we cannot release that information. I can only give you information about your claim.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] OK. Thank you so much for that. And uh additionally, can you please help me with the claim number?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Um, sure. The claim number is.
[AGENT][NEUTRAL] Let's 3456116.
[CUSTOMER][NEUTRAL] OK, can you please send a copy of UB to my fax number?
[AGENT][NEUTRAL] What is the fax number?
[CUSTOMER][NEUTRAL] Yes, the fax number is 925.
[CUSTOMER][NEUTRAL] 326-2202.
[AGENT][NEUTRAL] OK. That's 925-3262202 to your attention, Ms. [PII].
[CUSTOMER][NEUTRAL] Um, Health First CHC.
[AGENT][NEUTRAL] I'm sorry, can you spell that?
[CUSTOMER][NEUTRAL] Health first, H E A L T H Health. First, F I R S T.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] C H C
[AGENT][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Urgent care is 44.
[CUSTOMER][NEUTRAL] Old fashioned
[CUSTOMER][NEUTRAL] Black
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 458
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, I went ahead and send that over. Is there anything else I'm gonna help you with today, Ms. [PII]?
[CUSTOMER][POSITIVE] No, I got all the required information over this call. And yes, thank you for great assistance. And can I get the call reference number along with your name, please?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date. My name is [PII], that's [PII]. Last initial [PII].
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome.