AccountId: 011433970860
ContactId: 5384d602-6d91-4031-ba32-904909f7a0a4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 352859 ms
Total Talk Time (AGENT): 111127 ms
Total Talk Time (CUSTOMER): 69944 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/5384d602-6d91-4031-ba32-904909f7a0a4_20250520T19:04_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I'm calling from the Meadow Psychiatric Center to check the status of a claim.
[AGENT][NEUTRAL] Sure, I can help you with claim status. Can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK, and the policy number?
[CUSTOMER][NEUTRAL] The ID number is 02595576.
[AGENT][NEUTRAL] OK, one moment while I pull that up.
[AGENT][NEUTRAL] And can I get you to verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] And do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] I have the data service. I don't have the claim number. The data service is 41725 through 42925.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. One moment.
[AGENT][NEUTRAL] And would you like the claim number?
[CUSTOMER][POSITIVE] Yes please.
[AGENT][NEUTRAL] OK, it's 360.
[AGENT][NEUTRAL] 20
[AGENT][NEUTRAL] 67.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and let me see.
[AGENT][NEGATIVE] OK, it looks like that was denied.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Um, I've got two reasons here, so.
[AGENT][NEUTRAL] The first part of that claim was denied because the calendar year maximum for that benefit had been exhausted. Therefore, no additional benefits are payable for this calendar year.
[AGENT][NEUTRAL] And then the second half of your of that claim was denied due to the maximum total benefit of 180 days for any one period of confinement has been met.
[AGENT][NEUTRAL] So those were the two denial reasons.
[CUSTOMER][NEUTRAL] So basically they were out of lifetime phase.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Are we gonna receive that denial?
[AGENT][NEUTRAL] I can probably fax it to you if you give me just one moment.
[CUSTOMER][POSITIVE] OK great thanks.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sorry, can you confirm the provider name as well?
[CUSTOMER][NEUTRAL] It's the Meadow Psychiatric Center also known as UHS of Pennsylvania.
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] OK. And what is a good fax number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Let me read that back to you. I have [PII].
[CUSTOMER][NEUTRAL] That is correct and if you could put that to my attention, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, give me about 5 minutes, Pam, and I'll have that sent out.
[AGENT][NEUTRAL] Through fax. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] OK, that'd be great thank you.
[CUSTOMER][NEUTRAL] So basically to summarize both denials of the patient was out of days for the American public.
[AGENT][NEUTRAL] Right, they were out of, right, they were out of days and it looks like they had already met their calendar year maximum.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For the year. Mhm.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, and can I just have a call reference number please?
[AGENT][NEUTRAL] OK, we don't have call reference numbers, but you can use my name in today's date. So my name is [PII], last initial [PII] in today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK great thank you so much I appreciate all your help.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Any time. Thank you for calling APL and have a great day.
[CUSTOMER][NEUTRAL] You as well bye.