AccountId: 011433970860
ContactId: 6294eae4-1ad3-466f-8cd0-ce09d78fef53
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 616710 ms
Total Talk Time (AGENT): 189002 ms
Total Talk Time (CUSTOMER): 138642 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/6294eae4-1ad3-466f-8cd0-ce09d78fef53_20250102T13:07_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is Via calling on behalf of provider office to check on a claim status. How are you doing today?
[AGENT][POSITIVE] I'm good. I'm good. And you said that your name is [PII]? Is that correct?
[CUSTOMER][NEUTRAL] No, this
[AGENT][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am. OK. And we, yes, I can help you with claim status. What is your callback number?
[CUSTOMER][NEUTRAL] OK. The callback number is [PII].
[AGENT][NEUTRAL] Thank you. And how many claims for you do you have to check status on?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] How many?
[CUSTOMER][NEUTRAL] One.
[AGENT][NEUTRAL] OK. What is that member's policy number, please?
[CUSTOMER][NEUTRAL] OK. The policy number is 02455343.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] And [PII], any information that I do provide for you will be a
[AGENT][NEUTRAL] Verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEGATIVE] Uh no.
[CUSTOMER][NEUTRAL] Could you please repeat that again?
[CUSTOMER][NEGATIVE] It is breaking for me.
[AGENT][NEUTRAL] Any information that I provide for you today will be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK. The patient name is
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] September, what day? I'm sorry.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you. And the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] OK. The date of service is
[CUSTOMER][NEUTRAL] [PII] and the bill amount is
[CUSTOMER][NEUTRAL] $4,873.48.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the name of the facility?
[CUSTOMER][NEUTRAL] OK, the CD name is.
[CUSTOMER][NEUTRAL] Corpus Christi Medical Center.
[AGENT][NEUTRAL] OK, thank you. So this claim was received, the received date on this claim.
[AGENT][NEUTRAL] was [PII].
[AGENT][NEUTRAL] It was processed and denied on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 3532692.
[AGENT][NEUTRAL] And the reason for the denial on this claim states benefit maximum for this state of service has been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if, excuse me, [PII], if you need a copy of the explanation of benefits, you can print that from our portal by going to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, OK, one minute. Uh
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] One minute, let me check. Could you please hold for a moment?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. May I know the bill amount is, uh, who's responsibility?
[AGENT][NEUTRAL] Uh, we do not determine patient responsibility. We are not a major medical insurance carrier. That would be up to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know how much is the maximum benefit that the patient has?
[AGENT][NEUTRAL] For that date of.
[AGENT][NEUTRAL] For that data service, it was $150 and that was met on another provider's claim that was received prior to this claim.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] May I know the maximum beneficiary is $2 or visit?
[AGENT][NEUTRAL] Total, $150 as I just gave you.
[CUSTOMER][NEUTRAL] OK. Could you please verify that it is, uh, the patient only have $115 for that date of service or hold?
[AGENT][NEUTRAL] 150.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. May I know the allowed amount?
[AGENT][NEUTRAL] The amount that I just gave you, I, I explained to you this is not a major medical policy.
[AGENT][NEUTRAL] This is a limited benefit plan and the maximum for that data service was $150 that was paid on another claim that was received prior to this claim being received.
[CUSTOMER][NEUTRAL] OK. May I know the uh pay details?
[AGENT][NEGATIVE] I cannot provide that to you.
[AGENT][NEUTRAL] It was related to another provider.
[CUSTOMER][NEUTRAL] OK. Can I get the claim number for that?
[AGENT][NEUTRAL] No, I cannot give you another provider's claim number. I gave you the claim number for your claim.
[CUSTOMER][NEUTRAL] OK. One minute. Could you please hold for a moment?
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you for patiently waiting. And could you please provide me the
[AGENT][POSITIVE] Yes, and you're welcome.
[CUSTOMER][NEUTRAL] OK. Could you please provide me the card reference number?
[AGENT][NEUTRAL] Yes, ma'am. It is my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] OK. Thank you, [PII].
[AGENT][POSITIVE] You're very welcome. And is there anything else I can help you with?
[CUSTOMER][POSITIVE] Uh, no. Thank you for your time and assistance. Have a great day. Bye-bye.
[AGENT][POSITIVE] Absolutely. You're very welcome and I hope you have a nice day as well, and thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Uh-huh, bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.