AccountId: 011433970860
ContactId: 54c7e86d-ee6d-40f6-9890-0f2c39783261
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 355470 ms
Total Talk Time (AGENT): 105742 ms
Total Talk Time (CUSTOMER): 110472 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/54c7e86d-ee6d-40f6-9890-0f2c39783261_20250116T17:46_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] from provider's office was looking for the claim status. Could you help me with that?
[AGENT][NEUTRAL] Yeah, sure, I can assist you with claim status, Mr. [PII] May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] has the extension of [PII].
[AGENT][NEUTRAL] Thank you and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um, yeah, it's going to be.
[CUSTOMER][NEUTRAL] 02
[CUSTOMER][NEUTRAL] 2854
[CUSTOMER][NEUTRAL] 71.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] So, I have a patient's name is [PII]. The date of birth is [PII].
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] OK, thank you, and what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] according
[CUSTOMER][NEUTRAL] Sir, I have the data source is going to be?
[CUSTOMER][NEUTRAL] Um, 427 2023.
[CUSTOMER][NEUTRAL] Total charge is $1,312 even.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] For future you can check claim status online through our website at [PII] and that's just optional.
[AGENT][NEUTRAL] And you said the date of service was [PII] for $1,312 correct?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me pull this EB one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Tell me about.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEGATIVE] It doesn't.
[CUSTOMER][POSITIVE] I like.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Mm OK. I'm still waiting on the on the system on the paperwork.
[CUSTOMER][NEUTRAL] I know
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] In
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, so it looks like we processed this claim on [PII] and the claim was denied. The reason for this denial is that the maximum anesthesia benefits for the date of service has been exhausted.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the maximum so uh benefit is already exceeded, right? May I know when it was previously performed?
[CUSTOMER][NEUTRAL] 58536.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] My name is uh [PII].
[AGENT][NEUTRAL] OK, so the last payment I show here for the same um provider was $13.55.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] OK, but here we receive the correspondence that you just need the medical records to process a claim.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Here, uh, we have the correspondents.
[CUSTOMER][NEUTRAL] Which it is, uh, do you, is there any appeal for this claim?
[AGENT][NEUTRAL] OK, that, that's not our denial. Our denial is that the benefits has been exhausted. That's the only denial I got here and which is under the explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, what's the claim number?
[AGENT][NEUTRAL] OK, the claim number um is going to be 333-7251.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, could you repeat one more time? It's 333.
[AGENT][NEUTRAL] 333
[AGENT][NEUTRAL] Um 7251.
[CUSTOMER][NEUTRAL] Um, OK.
[CUSTOMER][NEUTRAL] 111.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Please move to the next patient.
[AGENT][NEUTRAL] OK, bear with me just a second. Let me make a note on this one before we move forward to the next one.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] On the the trip.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] In another case