AccountId: 011433970860
ContactId: 6bf4d184-3f01-46b6-824d-02e61909e230
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 215619 ms
Total Talk Time (AGENT): 60240 ms
Total Talk Time (CUSTOMER): 72936 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/6bf4d184-3f01-46b6-824d-02e61909e230_20250519T19:42_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello [PII], this is [PII] calling from provider's office to check up on a claim status. Also, this call is being recorded for quality and training purposes. Are you OK with that?
[AGENT][NEUTRAL] Yeah, that's fine. I'm happy to check on a claim. What's the policy number?
[CUSTOMER][NEUTRAL] Um, yeah, just give me a moment, the policy number would be 02538163.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] It's [PII] with the total charge amount $500 even actually I do have concern with this claim.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have a different bill amount after the primary paid?
[CUSTOMER][NEUTRAL] Yeah, it's $399 even.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, thank you for your patience. So the claim was received on [PII].
[AGENT][NEUTRAL] There was a benefit payment sent in the amount of $250. This was processed on [PII] of $25.
[CUSTOMER][NEUTRAL] Yeah, actually we have already received $250.
[CUSTOMER][NEUTRAL] I just need to know like uh members Primary insurance have processed this claim towards patients responsibility for $399 and you have paid only $250. So, uh what about remaining $149 which has been denied as maximum benefit met?
[AGENT][NEUTRAL] Correct. So the patient plan, their outpatient benefit max per calendar day is 250. There's nothing additional payable for that date of service. It is up to the facility or provider to decide if that is patient responsibility.
[CUSTOMER][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] Yeah, that was only my concern with this claim. Thank you so much for your help. Can you um help me with the call reference number for this number?
[AGENT][NEUTRAL] Call reference is my name with today's date. My name is [PII], that's [PII], last initial [PII], and then today's date.
[CUSTOMER][POSITIVE] OK, sir, uh thank you so much for your help. Hope you have a wonderful day. Thank you.
[AGENT][NEUTRAL] You too. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.