AccountId: 011433970860
ContactId: 666e1f9f-e5f0-42f5-970e-4afaf4ede3a7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 411119 ms
Total Talk Time (AGENT): 137107 ms
Total Talk Time (CUSTOMER): 96385 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/666e1f9f-e5f0-42f5-970e-4afaf4ede3a7_20250502T21:17_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] If you
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from Provider Office Surgery Center at [PII]. Could you please spell out your name for me?
[AGENT][NEUTRAL] Sure, that's [PII].
[CUSTOMER][NEUTRAL] This call is being recorded.
[CUSTOMER][POSITIVE] Thank you so much, sir.
[AGENT][NEUTRAL] Yes, and how may I assist you today, Mr. [PII]?
[CUSTOMER][NEUTRAL] Uh, to check the status of a claim.
[AGENT][NEUTRAL] Claim status? Sure, and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Uh, the callback number is [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the name of the facility you're calling from from my location?
[CUSTOMER][NEUTRAL] Surgery center at [PII].
[AGENT][NEUTRAL] OK. And may I have the patient's policy number?
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] 01807645
[AGENT][NEUTRAL] Thank you. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Uh, patient name is uh [PII] and the date of birth, [PII].
[AGENT][POSITIVE] Perfect, thank you.
[AGENT][NEUTRAL] And may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Trade of service is uh [PII]. The bill amount $3,321 even.
[AGENT][NEUTRAL] OK, thank you. [PII] $3,32121. Is that correct?
[CUSTOMER][NEUTRAL] Yeah, yes.
[AGENT][NEUTRAL] No, OK.
[AGENT][NEUTRAL] And Mr. [PII], for future, you can check claim status online through our website at [PII] and that's just optional and bear with me, let me pull the explanation of benefits.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] Go one more minute. I'm waiting on the EOB.
[CUSTOMER][NEUTRAL] This is.
[AGENT][NEUTRAL] All right, it looks like we processed the claim on [PII] and the claim was denied. The reason for this denial is that outpatient benefits for the calendar year has been met.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Hello, Mr. [PII].
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] How many outpatient visits that the member has?
[AGENT][NEUTRAL] You need to know the benefit amount?
[CUSTOMER][NEUTRAL] OK. I'll check with the patient benefits, uh,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there any payment was made on this or?
[AGENT][NEGATIVE] No, it was denied. It was denied. The denial reason is outpatient benefits for the calendar year has been met.
[CUSTOMER][NEGATIVE] No payment.
[AGENT][NEUTRAL] So the be the benefit has been exhausted for outpatients.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, can I have the UB through fax? I'll forward the fax number.
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] It is uh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] To what attention?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Attention to [PII]
[AGENT][NEUTRAL] OK. Do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][NEUTRAL] OK. Uh, may I know the same received date and denied date?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, yes, um, bear with me.
[AGENT][NEUTRAL] It was received [PII] and it was processed [PII].
[AGENT][NEUTRAL] And Mr. [PII], I'm gonna put you on a brief hold so I can send this fax over to you, OK? One moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for you, Mr. [PII]. Yeah, I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I'm gonna help you with today?
[CUSTOMER][NEUTRAL] Um, can I have the claim number?
[AGENT][NEUTRAL] Sure. My claim number is 353-6184.
[CUSTOMER][NEUTRAL] Is there any active insurance for this member?
[AGENT][NEUTRAL] Um, let me see, one moment.
[AGENT][NEUTRAL] This policy is active still.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I have the call reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name and today's date if you will.
[CUSTOMER][POSITIVE] Thank you so much, sir.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] Um, nothing else needed. Uh, thank you so much. Have a great day. Happy weekend.
[AGENT][POSITIVE] You're welcome. You as well, and thank you for calling APL. Bye-bye.