AccountId: 011433970860
ContactId: 6e9c5001-df9f-4e20-a952-3886535ad231
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 598330 ms
Total Talk Time (AGENT): 136562 ms
Total Talk Time (CUSTOMER): 172832 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/6e9c5001-df9f-4e20-a952-3886535ad231_20250213T18:57_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes. Yes, thank you. Good afternoon. I am [PII] calling from provider office looking for claims status.
[AGENT][NEUTRAL] OK, and can you please spell your name for me, sir? I can help you with claim status.
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][POSITIVE] OK, thank you so much and then what is your callback number?
[CUSTOMER][NEUTRAL] Yes, my callback number is [PII].
[AGENT][NEUTRAL] Thank you. And then what is the patient's name?
[CUSTOMER][NEUTRAL] Yeah, ma'am. My patient name is
[CUSTOMER][NEUTRAL] [PII] and last name is [PII], and date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then what's the patient's policy number?
[CUSTOMER][NEUTRAL] Spe policy number is 02156.
[CUSTOMER][NEUTRAL] 229
[AGENT][NEUTRAL] OK, let me look that up.
[AGENT][NEUTRAL] OK, I've got [PII]'s policy pulled up. What is the date of service?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Well one
[CUSTOMER][NEUTRAL] Yes, data services.
[CUSTOMER][NEUTRAL] [PII]. And the bill amount is
[CUSTOMER][NEUTRAL] 215 15 $15 saving.
[AGENT][NEUTRAL] OK, and then what is the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Ma'am, I do not, uh, I don't have, uh,
[CUSTOMER][NEUTRAL] Uh, this information.
[AGENT][NEUTRAL] OK, and then what is the name of the facility you're calling for?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] My facility name is
[CUSTOMER][NEUTRAL] Dual chiropractic and acupuncture.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold, Ollie, while I look up this claim for you and I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me, [PII]. I did find the claim for you. Uh, the claim number is 355.
[CUSTOMER][NEUTRAL] When
[AGENT][NEUTRAL] 2
[CUSTOMER][NEUTRAL] Yeah, yes, one moment, ma'am. Sorry, sorry, sorry, disturbing, sorry for disturbing. Uh, provide me the claim number.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] 355-2025
[CUSTOMER][NEUTRAL] 355
[CUSTOMER][NEUTRAL] 2025
[AGENT][NEUTRAL] Yes, it was reported on [PII].
[CUSTOMER][NEUTRAL] OK, ma'am. Uh ma'am, sorry.
[AGENT][NEUTRAL] And processed on.
[CUSTOMER][NEGATIVE] Ma'am, ma'am, sorry. Your voice is uh very breaking, so.
[CUSTOMER][NEUTRAL] Set your mic, please.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK, yes, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Claim number is 3552025. That is correct, ma'am?
[AGENT][NEUTRAL] Yes, the claim
[AGENT][NEUTRAL] Number is 355-2025.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It was reported on [PII].
[CUSTOMER][NEUTRAL] Yes, it means uh [PII].
[AGENT][NEUTRAL] No, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], yeah [PII].
[CUSTOMER][NEUTRAL] Yeah, yeah. OK, ma'am. Sorry.
[AGENT][NEUTRAL] And then it was processed on [PII].
[CUSTOMER][NEUTRAL] Yes, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And it was denied because the office visits for the calendar year have been met.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh, what, what is [PII] name?
[AGENT][NEUTRAL] Because the outpatient office visits for calendar year were met.
[CUSTOMER][NEUTRAL] It means uh the timely filing limit is uh crossed.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] I mean she gets 4 office visits per calendar year and she used them all up.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, OK, OK, because uh the visit.
[AGENT][NEUTRAL] Be benefits was exhausted.
[CUSTOMER][MIXED] Excess, OK. Benefit is excess.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, ma'am, how many visit in, uh, per, per year?
[AGENT][NEUTRAL] 4
[CUSTOMER][NEUTRAL] Only 4.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And uh he will, uh yeah.
[CUSTOMER][NEUTRAL] Uh, cross, uh, it means to visit for, for more than 4.
[CUSTOMER][NEUTRAL] Limit is grass
[AGENT][NEUTRAL] This is a secondary insurance.
[AGENT][NEUTRAL] And she it's limited, yes.
[CUSTOMER][NEUTRAL] OK. Uh, yeah.
[CUSTOMER][NEUTRAL] OK. One moment, ma'am.
[CUSTOMER][POSITIVE] OK, ma'am. Thank you.
[CUSTOMER][NEUTRAL] Ma'am, uh you received, yes, sorry, sorry, ma'am. OK. And receipt date is uh uh [PII], and uh I submit the claim on [PII], you will receive on same day.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] This was for the year of [PII] and she had her office visits. So even if you submitted it on [PII], the date of service was still for [PII] was still for [PII].
[CUSTOMER][POSITIVE] OK. OK, ma'am. Thank you. Thank you for assisting. And uh call reference number?
[AGENT][NEUTRAL] You can use my name, [PII].
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] And last initial?
[AGENT][NEUTRAL] A
[CUSTOMER][POSITIVE] [PII]. OK. Thank you. Thank you for assisting. Have a nice day. Take care. Bye-bye for now.
[AGENT][POSITIVE] Bye bye [PII] you have a good day too thanks for calling APL.