AccountId: 011433970860
ContactId: 6e73e6a9-db0d-4e1a-b1e1-1c8c87a2b1ed
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 296130 ms
Total Talk Time (AGENT): 99279 ms
Total Talk Time (CUSTOMER): 132099 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/6e73e6a9-db0d-4e1a-b1e1-1c8c87a2b1ed_20250328T14:50_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]. I'm calling you from provider's office. I need the claim status.
[AGENT][NEUTRAL] Sure, I can check on a claim for you. I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. That is [PII].
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Yes, I have the policy number is
[CUSTOMER][NEUTRAL] 02555967
[AGENT][NEUTRAL] OK and uh what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Patient name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that uh what was the date of service for this claim?
[CUSTOMER][NEUTRAL] I have the date of service is [PII] with the bill amount is $155 even and the primary insurance process the claim, yes. Primary insurance process the claim towards the co-insurance and that is left over to the APL. So the APL giving this uh denial, so I want to know about the denial why you denied the claim.
[AGENT][NEUTRAL] Got it. OK. Uh-huh.
[AGENT][NEUTRAL] OK, yeah, give me just a moment. Do you happen to have that claim number by chance, Tay?
[CUSTOMER][NEUTRAL] Yeah, sure. I have 3572384.
[AGENT][NEUTRAL] OK thank you one moment let me find that.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, no issue.
[CUSTOMER][NEUTRAL] What's the name?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] Of course one moment.
[CUSTOMER][NEUTRAL] Let
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So the reason we're unable to make this payment Tao is that the uh maximum benefit for this particular consignment had already been paid.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and can you please tell me your allowed amount?
[AGENT][NEUTRAL] Yes, one moment, let me get that for you.
[CUSTOMER][NEUTRAL] So uh
[AGENT][NEUTRAL] OK, so inpatient benefit per consignment is $1000.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, just hold on.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] What is your allowed amount?
[AGENT][NEUTRAL] It's $1000 per consignment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] But primary paid the claim only $117.38.
[AGENT][NEUTRAL] Right, so the allowed amount total was $1000 which had already been met prior to this claim.
[AGENT][NEGATIVE] So we were unable to pay an additional benefit.
[CUSTOMER][NEUTRAL] OK, so I would.
[CUSTOMER][NEUTRAL] OK, just hold on.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Uh, can you just give me the allowed amount for this data of service so that I can pull up my, I can make my notes.
[AGENT][NEUTRAL] Sure, it's not for the date of service it's for the uh confinement as a whole as this is an inpatient uh claim, so that's $1000 max per confinement which had already been met prior to this claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, just hold on. So this is the provider, right for the patient responsibility.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] We do not say what is patient responsibility, that would be up to the provider.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, thank you so much for this information, [PII]. Have a wonderful day bye bye.
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] Yeah, was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] No, no, can you please provide me the call reference number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date, uh, so my last initial is A.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, thank you so much. Have a wonderful day bye bye.
[AGENT][POSITIVE] Of course thanks Con ATL. You too, bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.