AccountId: 011433970860
ContactId: 701b15ef-3913-4d02-94d6-f8ca7d1756fd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 193990 ms
Total Talk Time (AGENT): 72633 ms
Total Talk Time (CUSTOMER): 54136 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/701b15ef-3913-4d02-94d6-f8ca7d1756fd_20250121T18:28_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII]. I was calling to get more uh details on the claim denial.
[AGENT][POSITIVE] OK [PII], I'm happy to check on a claim for you. Do you have a policy number?
[CUSTOMER][POSITIVE] Yes, I get it.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK, member ID number is
[CUSTOMER][NEUTRAL] This is
[CUSTOMER][NEUTRAL] Wait, hold on.
[CUSTOMER][NEUTRAL] OK. It's 01.
[CUSTOMER][NEUTRAL] 072145
[AGENT][NEUTRAL] All right, let me pull this up here.
[AGENT][NEUTRAL] And if I could get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] [PII]. Last name spelled [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] Thank you so much. And then what is the date of service?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And they build them out.
[CUSTOMER][NEUTRAL] $3,022.60.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] OK, so it looks like we did receive the claim. It looks like the claim was denied stating the maximum amount payable for this occurrence has been met. Uh, per occurrence means treatment for the same or related condition unless separated by 90 days.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So in this case, would they uh assume that this would be the patient responsibility being that they benefits as me.
[AGENT][NEUTRAL] Yeah, so it looks like we're not able to advise on what patient responsibility would be that's up to the facility or provider. The patient's plan pays a max of $500 per current, so it looks like that's been exhausted.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alrighty, can I get a call reference number?
[AGENT][NEUTRAL] Absolutely. Call reference is my name with my last initial and then today's date. My name again is [PII], that's spelled [PII] Last initial to my name is [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much, Ms. [PII]. You have a good day.
[AGENT][NEUTRAL] You too. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.