AccountId: 011433970860
ContactId: 55035ff4-fb3d-47bc-85e8-d7ce0fe732fb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 597510 ms
Total Talk Time (AGENT): 149966 ms
Total Talk Time (CUSTOMER): 230091 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/55035ff4-fb3d-47bc-85e8-d7ce0fe732fb_20250505T15:02_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] calling from provider office. Can you please help me with the claim status?
[AGENT][NEUTRAL] Yes, I can help with claim status. I didn't catch your name. What was that?
[CUSTOMER][NEUTRAL] Right. [PII].
[AGENT][NEUTRAL] OK, so do you have the a good callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the policy number of the patient?
[CUSTOMER][NEUTRAL] Yeah, it's 02413470. M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] And what was the date of service and bill charges?
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII] and the total charge amount is $2180 even.
[AGENT][NEUTRAL] OK. OK, looks like we received the claim on.
[AGENT][NEUTRAL] It was received 13-2025.
[AGENT][NEUTRAL] Process 17 2025.
[AGENT][NEUTRAL] Uh, the outpatient dollar amount for the calendar year was met.
[CUSTOMER][NEUTRAL] Can you please repeat it once?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, may I know the present claim status?
[AGENT][NEUTRAL] It was denied the outpatient benefit for the calendar year was met.
[CUSTOMER][NEUTRAL] OK, the claim was denied, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Patient, uh, uh, max amount was met, right?
[AGENT][NEUTRAL] Yes, the maximum benefit payable for the calendar year was met.
[CUSTOMER][NEUTRAL] Just give me a moment.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, just give me a moment. I will check it once.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello. Hello.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, can you please talk with my supervisor?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][POSITIVE] Yes, how can I help you?
[CUSTOMER][POSITIVE] Yeah, hi. Good morning. Yeah. Thank you so much for the information. Uh, may I know your good name, please?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, can you please help me with your name, how to spell your name?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][POSITIVE] Thank you so much. After [PII], correct?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] At last
[CUSTOMER][NEUTRAL] Uh, by the way, my name is [PII]. It is spelled as [PII]. Thank you so much for the information. The claim denial due to, uh, the patient was already met is out of pocket maximum amount, right?
[AGENT][NEUTRAL] No, the patient, we'd already paid out the benefit amount maximum for the calendar year.
[AGENT][NEUTRAL] So they have an outpatient benefit maximum payout of 1250 and that had already been paid on a different claim.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK. Uh,
[CUSTOMER][NEUTRAL] How much the allowed amount for this annum, uh, for this year?
[CUSTOMER][NEUTRAL] The yearly out of pocket.
[AGENT][NEUTRAL] The max
[AGENT][NEUTRAL] This is a secondary policy, so it pays a maximum of 1250.
[AGENT][NEUTRAL] For outpatient services.
[AGENT][NEUTRAL] After primary pace.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um, thank you so much, but, uh, uh, you're paying this one previously, right?
[AGENT][NEUTRAL] We paid it, so the max that we'll pay for claims that we received for outpatient services in a calendar year is 1250.
[AGENT][NEUTRAL] When we received this claim, 1250 had already been paid out for the calendar year.
[CUSTOMER][NEUTRAL] OK. Thank you so much. Can you please help me with the last, uh lastly paid claim number that could help us to documentation purpose?
[AGENT][NEUTRAL] We, we can give you claim status on claims that you call for, for your provider. So that's, that's the only information that I can give you.
[AGENT][NEUTRAL] I can just tell you that it was previously met.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh, yeah, actually, I'm asking, I'm from facility, just I am asking for when the patient was met is out of pocket, uh, amount and which under the claim number also. I'm asking just for the information for the documentation purpose.
[CUSTOMER][NEUTRAL] And we will uh reach out to the patient regarding this claim claim number and we will set to uh we are explained to the patient you are met already out of pocket amount for this under this claim number. That's the reason I'm asking for the claim which the patient was lastly met his out of pocket amount.
[AGENT][NEUTRAL] Right, but I, I can't give you claim information for a different provider. Um, let me see if I can see what date it was met. Hold on one moment.
[AGENT][NEUTRAL] Yeah, it doesn't give me a date. So, and there's, there's a lot of claims on file. I'd have to search one by one, so.
[AGENT][NEUTRAL] It was just met before you the this claim was submitted.
[AGENT][NEUTRAL] So you'd have to contact the patient with any other information?
[CUSTOMER][NEUTRAL] OK, can you, uh, if, if it's possible to help me with the claim number for the matting out of maximum amount, uh, as like as offset, uh, we are
[AGENT][NEUTRAL] You need the claim number for this claim?
[CUSTOMER][NEUTRAL] This claim, uh, yeah, can you please?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 3354.
[AGENT][NEUTRAL] 8358.
[CUSTOMER][NEUTRAL] 8358.
[AGENT][NEUTRAL] Yes, 354-835-8.
[CUSTOMER][NEUTRAL] OK. And
[CUSTOMER][POSITIVE] Thank you so much. Uh,
[CUSTOMER][NEUTRAL] And previously uh claim number?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Actually, I'm asking for previous claim number. The patient was out of service, out of service or out of pocket amount.
[CUSTOMER][NEUTRAL] Pa
[AGENT][NEUTRAL] That's what I don't, I, there's several claims on here and I don't show a date, so I, I, we can't give claim information for other providers that you're not.
[AGENT][NEUTRAL] I can only give you claim information for your provider.
[AGENT][NEUTRAL] So
[CUSTOMER][POSITIVE] OK. Thank you so much for the.
[AGENT][NEUTRAL] OK. Is there any?
[CUSTOMER][POSITIVE] Uh, thank you so much for the information. Uh, can you please help me with the call reference number?
[AGENT][NEUTRAL] Yes, it's my name, [PII], and today's date.
[CUSTOMER][POSITIVE] Thank you so much. Uh, I will hand out to
[CUSTOMER][POSITIVE] Uh, [PII], uh, she will talk to the remaining call. Thank you so much. It's nice talking to you. Have a good.
[AGENT][POSITIVE] OK, thank you for calling APL. Bye-bye.