AccountId: 011433970860
ContactId: 76f555b0-3810-4b62-8d20-5830a4fdab85
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 216179 ms
Total Talk Time (AGENT): 73306 ms
Total Talk Time (CUSTOMER): 68422 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/76f555b0-3810-4b62-8d20-5830a4fdab85_20250513T19:00_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling about claims for a member.
[AGENT][POSITIVE] OK, well I'll be more than happy to help you with the claims and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, that is [PII].
[AGENT][NEUTRAL] Thank you for that and the member's policy number?
[CUSTOMER][NEUTRAL] That is 01871611.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, [PII], sorry, [PII].
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the um total bill and the date of service?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Day of service is um [PII] for $115.
[AGENT][NEUTRAL] OK, did you have multiple or just the one?
[CUSTOMER][NEUTRAL] Uh, just the one today.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And it was for 1:15?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It was, he did, um, he had labs done.
[CUSTOMER][NEUTRAL] I just need to know why it was denied as non-covered and if we're allowed to bill the um patient for the balance.
[AGENT][NEUTRAL] Do you have a claim number?
[CUSTOMER][NEUTRAL] Um, let me see if I can pull it.
[AGENT][NEUTRAL] 259.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] 3507274
[AGENT][NEUTRAL] OK, before I went to the one above it. All right, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the denial reason? Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it's the same for all three lines. OK, so the, the claim was denied because the the calendar year max for outpatient services was met.
[CUSTOMER][NEUTRAL] OK, so Benefit max for.
[CUSTOMER][NEUTRAL] Um, the year.
[AGENT][NEUTRAL] Right, for [PII], um, and in terms of the patient responsibility, we don't determine that because we're not a major medical insurance company.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alrighty, may I have a call reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. First initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, today's day alright.
[CUSTOMER][POSITIVE] Thank you so much, [PII]. You have a great day.
[AGENT][POSITIVE] Thank you, [PII]. You also, was there anything else I can help with?
[CUSTOMER][POSITIVE] Uh, no, not at this time. Thank you. Have a good day.
[AGENT][POSITIVE] Alright, thanks for calling APL. You're welcome. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.