AccountId: 011433970860
ContactId: 5cc89369-5106-4884-8712-2988f559a5bb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 252740 ms
Total Talk Time (AGENT): 88596 ms
Total Talk Time (CUSTOMER): 66546 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/5cc89369-5106-4884-8712-2988f559a5bb_20250224T15:09_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] Yeah, hi. My first name is [PII] and last initial is [PII]. I'm checking your claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status. And [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, my callback number is [PII]. It's [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, yeah, member ID would be 01734133 M as in Mary, L as in Lima, number 7.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, the patient's first name is [PII].
[CUSTOMER][NEUTRAL] And the last name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth of patient 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 and the total bills for the claim?
[CUSTOMER][NEUTRAL] Yes, the data service is [PII], and the total charge amount is $245 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yes, the provider name is Urgent Care Medical Associates LLC.
[AGENT][NEUTRAL] Alright, so I'm showing that we received the claim on [PII]. I'm sorry.
[AGENT][NEUTRAL] The claim number is 355-0663.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because the outpatient benefit for the calendar year has been met.
[CUSTOMER][NEUTRAL] Sorry, the outpatient?
[AGENT][NEUTRAL] The outpatient benefit for the calendar year has been met?
[CUSTOMER][NEUTRAL] OK. Therefore, this is a non-covered charges, right?
[AGENT][NEUTRAL] No, it's not that it's not covered. Their benefit maximum was used.
[CUSTOMER][NEUTRAL] OK, so who's responsible for the total charge amount of $245 even?
[AGENT][NEUTRAL] That would be up to your policies. Um, we don't determine patient responsibility because we're not a major medical. So, however, you all do outstanding balances.
[CUSTOMER][POSITIVE] Outstanding balances, right?
[AGENT][NEUTRAL] Right, or remaining balances.
[CUSTOMER][NEUTRAL] OK, so only patient responsibility, right?
[AGENT][NEUTRAL] We do not determine patient responsibility, that is up to your policies on outstanding or remaining balances.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK what is the call reference number?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. Again, that's [PII] to my last name is [PII].
[CUSTOMER][POSITIVE] OK. OK, thanks for the information. Have a great day.
[AGENT][POSITIVE] You're welcome. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] No, nothing for today. Thanks for asking.
[AGENT][POSITIVE] Alright, thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah, bye bye.