AccountId: 011433970860
ContactId: 6ce5a61b-e834-4d03-861b-8d92ef0236fe
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 476299 ms
Total Talk Time (AGENT): 182951 ms
Total Talk Time (CUSTOMER): 185810 ms
Interruptions: 5
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/6ce5a61b-e834-4d03-861b-8d92ef0236fe_20250115T19:24_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the provider's office to check on the claim status.
[AGENT][POSITIVE] OK, I'm so sorry. What did you say your name was?
[CUSTOMER][NEUTRAL] It's [PII] I'm so sorry. You're gonna have to spell that again.
[AGENT][NEUTRAL] I'm so sorry. You're gonna have to spell that again for me.
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, thank you, [PII], and your callback number?
[CUSTOMER][NEUTRAL] Uh, it's [PII] direct line.
[AGENT][NEUTRAL] Thank you. And [PII], how many claims do you have to check status on today?
[CUSTOMER][NEUTRAL] Uh, just only one claim.
[AGENT][NEUTRAL] OK. And what is that member's policy number, please?
[CUSTOMER][NEUTRAL] What is that
[CUSTOMER][NEUTRAL] Mm. Yeah. The policy number is 1905619.
[AGENT][NEUTRAL] OK thank you one moment please.
[AGENT][NEUTRAL] And [PII], any information that I do 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] I know any information that I could provide for you today?
[CUSTOMER][NEUTRAL] The patient name is [PII] and the date of birth is [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] What is the month?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] OK, and what is the date of service and total bill amount for a place?
[CUSTOMER][NEUTRAL] Uh, the date of service is [PII], and the total bill value is $629 even.
[AGENT][NEUTRAL] 629 is the amount, is that correct?
[CUSTOMER][NEUTRAL] $629 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Just one moment, please. What is the facility name?
[CUSTOMER][NEUTRAL] It's Express Sergeant Care always called us Williams Group Medical Practice.
[AGENT][NEUTRAL] OK, so this claim was received on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] The claim number mhm.
[CUSTOMER][POSITIVE] Just process done, done.
[AGENT][NEUTRAL] One moment and let me get back to that screen. 12:16.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] Fine.
[AGENT][NEUTRAL] The claim number is 3541182.
[CUSTOMER][NEUTRAL] 35411
[AGENT][NEUTRAL] 82.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 82.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] This claim was denied?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And the reason for the denial states outpatient benefits.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] For this calendar year has been met.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Has been met.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] For kind uh uh for this policy, the patient, how many um we he has? Could you explain that for me?
[AGENT][NEUTRAL] On this supplemental policy, the outpatient benefit max.
[AGENT][NEUTRAL] Per calendar year.
[AGENT][NEUTRAL] I 4.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, $4500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For covered outpatient services and that had already been met prior to this claim being received.
[CUSTOMER][NEUTRAL] No, I'm asking, uh, what's the total?
[CUSTOMER][NEUTRAL] Just give me a minute, just give me a minute.
[AGENT][NEUTRAL] If this is not major medical insurance, [PII]. This is a supplemental policy, and on this policy, that benefit information that I provided for you is the calendar your benefit. It's not a specific number, it is a dollar amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, OK, OK, OK. I can get you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What's the total dollar amount you have said before? Could you spell that again for me? Could you tell that to me?
[AGENT][NEUTRAL] Yes, sir, give me just one moment, please.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Like.
[CUSTOMER][NEUTRAL] How much?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] The outpatient benefit max is $4500 for covered person per calendar year for covered outpatient services.
[CUSTOMER][NEUTRAL] It's $4500 per year, right? For the.
[AGENT][NEUTRAL] For calendar year for covered outpatient services.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] You a
[AGENT][NEUTRAL] And if you need a copy of this explanation of benefits, [PII], you may print it by going to our portal website at [PII].
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 51276855.
[CUSTOMER][NEUTRAL] Uh, I think.
[AGENT][NEUTRAL] And is there anything else that I can help you with today on this member's policy?
[CUSTOMER][NEUTRAL] Uh, yeah, could you, could you spell your name for me?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] First initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And my name along with today's date will be your call reference number.
[CUSTOMER][NEUTRAL] Today's date, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And if that's all then that I can help you with today, [PII]? Is that, is that everything?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Um, may I know when the patient has last, uh, on which date of service the patient has made the
[AGENT][NEUTRAL] I, I cannot provide you, yes, I cannot provide you another provider's claims information.
[CUSTOMER][NEUTRAL] Um, can.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Then I think that's for the day.
[AGENT][POSITIVE] OK. Well, if that's all then that I can help you with, thank you for calling APL and I hope that you have a very nice afternoon.
[CUSTOMER][POSITIVE] Yeah, have a nice day. Bye-bye.
[AGENT][POSITIVE] You too. Thank you. Bye-bye.