AccountId: 011433970860
ContactId: 52fd4571-15eb-4c69-ab6d-6929dfda0bc4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 368910 ms
Total Talk Time (AGENT): 115239 ms
Total Talk Time (CUSTOMER): 74716 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/52fd4571-15eb-4c69-ab6d-6929dfda0bc4_20250402T12:51_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from pro office to check a claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, [PII], and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] So, the callback number is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, may I have the member's policy number?
[CUSTOMER][NEUTRAL] Sure, the member's policy number is
[CUSTOMER][NEUTRAL] 023445
[CUSTOMER][NEUTRAL] 90 M as in Mike L as in Lima and 7.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure, the number's name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim and the total bills?
[CUSTOMER][NEUTRAL] Sure, the data services [PII] and the total bill amount is $6,456 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] It's pediatrics medical group.
[AGENT][NEUTRAL] OK. And again, just for the call, the information provided is a verification of benefits, not a guarantee of payment. I'm showing that we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 351.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 9610.
[AGENT][NEUTRAL] And on [PII], the claim was denied. Hold on one moment for the denial reason.
[CUSTOMER][NEUTRAL] OK, could you repeat the claim number again? 351-9610.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Well, that's all. OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And hold on one moment for the denial reason.
[AGENT][NEUTRAL] Um, the inpatient benefit for the calendar year has been met. So they've used their, um, inpatient max for the year.
[CUSTOMER][NEUTRAL] Sorry, could you repeat it calendar? Could you repeat that?
[AGENT][NEUTRAL] The calendar year max for inpatient benefits has been used.
[CUSTOMER][NEUTRAL] Just to, can I put the call on hold for a minute?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Can we build the patient that now?
[AGENT][NEUTRAL] Um, so we don't determine patient responsibility. The outstanding balance would be, um, whatever your procedures are for remaining or outstanding balances.
[CUSTOMER][NEUTRAL] Uh, may I know the for, uh, how many, uh, how many we can use for the year?
[CUSTOMER][NEUTRAL] Hello
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] The allowed amount would have been the calendar year max, which was $3000 but by the time your claim came in, it had already been used, so we couldn't apply anything.
[CUSTOMER][NEUTRAL] So what do you have to do then with the claim?
[AGENT][NEUTRAL] So that will be up to you and your company, whatever your procedures are for outstanding or remaining balances. APL does not provide that, which is why it's not on the explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, just a minute, uh, I just need another one moment. Can I put the call on hold for a minute?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sorry for the long hold, you know. May I know the call reference number for us today?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Could you spell your name again?
[AGENT][NEUTRAL] Sure, my name is [PII]
[CUSTOMER][NEUTRAL] What
[CUSTOMER][POSITIVE] Thanks. Thanks for your assistance.
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] That's all I know. Thanks for assistance. Have a great day.
[AGENT][POSITIVE] All right, thanks for calling APL. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye bye.