AccountId: 011433970860
ContactId: 5c37838d-88f9-4d3d-82bf-79451a10a189
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 504000 ms
Total Talk Time (AGENT): 191547 ms
Total Talk Time (CUSTOMER): 108993 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/5c37838d-88f9-4d3d-82bf-79451a10a189_20250203T21:50_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. This is [PII] from the provider's office. I to check on the claim status. How are you doing today?
[AGENT][NEUTRAL] I'm sorry. Uh, I'm very sorry. I can barely hear you.
[CUSTOMER][NEUTRAL] Can you hear me now, [PII]?
[AGENT][MIXED] And that, that is better. And I, but I couldn't understand your name.
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Hi, [PII]. OK. And you, how can I help you today?
[CUSTOMER][NEUTRAL] some more flight charges.
[AGENT][NEUTRAL] You needing claim status, I can help you.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] What is your callback number please, [PII]?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you. And how many clients, [PII], do you have?
[CUSTOMER][NEGATIVE] I have 2 claims for the call.
[AGENT][NEUTRAL] OK. Are the claims for the same patient in different dates of service or to different patients?
[CUSTOMER][NEUTRAL] Inpatient, different data service.
[AGENT][NEUTRAL] OK, and any information [PII] that I do provide for you will be a verification of benefits and not a guarantee of payment and you will use my name along with today's date if you need a call reference number for our call today. And then also [PII] if we do have a claims on file and you need the explanation of benefits, you can go to our portal and print those and our portal website to print from is secured.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Secure. [PII].
[AGENT][NEUTRAL] That is correct, yes. And [PII], what is the policy number?
[CUSTOMER][NEUTRAL] The policy number is um
[CUSTOMER][NEUTRAL] 02512377.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And you said it is the same patient with 2 dates of service, is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, and if you could please verify your patient's name and date of birth.
[CUSTOMER][NEUTRAL] It is uh [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the first day of service and total bill amount?
[CUSTOMER][NEUTRAL] It is [PII] with the amount of $546 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, bear with me just a moment while I'm looking through some information.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] What is the facility name?
[CUSTOMER][NEUTRAL] Community Medical Associate.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so this claim was received.
[AGENT][NEUTRAL] The received date on this claim was [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was processed and denied on [PII].
[CUSTOMER][NEUTRAL] The claim number?
[AGENT][NEUTRAL] The claim number is 3536649.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the reason for the denial on this claim, [PII] states the calendar year maximum for outpatient office visits due to sickness and or accident has been met for this calendar year.
[CUSTOMER][POSITIVE] Maximum benefit met or of the visit.
[AGENT][NEUTRAL] Uh, calendar year, that is correct.
[CUSTOMER][NEUTRAL] On calendar year.
[CUSTOMER][NEUTRAL] All right. And um
[CUSTOMER][NEUTRAL] So, uh, is it, uh, is it that the total bill amount is processed towards the member patient responsibility?
[AGENT][NEUTRAL] Uh, we do not determine patient responsibility. That would be up to the provider.
[CUSTOMER][NEUTRAL] Right. So, we haven't received any OB so far for this denial. So,
[AGENT][NEUTRAL] Yes sir, and that's where you can print from, you can use that claim number I gave you and print the EOB from the secured. [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] [PII]. All right. May I have the call? OK. All right, [PII]. Thank you so much for your help.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yeah, mhm, and you're welcome. And was there another data service for the same number?
[CUSTOMER][NEUTRAL] It has the same, uh, reason, ma'am.
[AGENT][NEUTRAL] Oh, OK. So that you don't have another date to check?
[CUSTOMER][NEUTRAL] I have, I do have, but I need a new for that. As you said, we can get it from the portal. I can log into the portal.
[AGENT][NEUTRAL] Yes, sir, but I'll need to
[AGENT][NEUTRAL] Uh-huh. And I, but do you want me to provide you the claim number that you will need to use to print your EOB?
[AGENT][NEUTRAL] I gave you the claim number for this first one, so what is the next date of service and total bill amount?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yeah, just give me one minute.
[CUSTOMER][NEUTRAL] The total bill amount is um
[CUSTOMER][NEUTRAL] $228. And the rate of service is [PII].
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] OK, so we also received a claim for this data service and the bill amount.
[AGENT][NEUTRAL] Just one moment, I'll provide you that information.
[AGENT][NEUTRAL] OK, so this claim was received on [PII], processed on [PII].
[AGENT][NEUTRAL] The claim number is 35147997.
[AGENT][NEGATIVE] And this was also denied for the same reason.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] All right. Yes, ma'am.
[CUSTOMER][POSITIVE] All right, then. Thank you so much for your help. You have a wonderful day.
[AGENT][POSITIVE] OK. Well, well, I hope you have a wonderful day too, [PII] if that's all I can help you with, and thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] Mm, bye-bye.