AccountId: 011433970860
ContactId: 775e7076-e164-4f0c-a74b-049538b452d7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 592479 ms
Total Talk Time (AGENT): 170486 ms
Total Talk Time (CUSTOMER): 144064 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/775e7076-e164-4f0c-a74b-049538b452d7_20250203T20:46_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, my name is [PII] calling to check on a claim.
[AGENT][NEUTRAL] OK, you're needing to check on a claim, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am, I can help you with that. And I'm sorry, did you say your name is [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]. OK, I'm sorry, [PII]. Thank you. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII], it's a direct line.
[AGENT][NEUTRAL] Thank you. And you have just one claim salary to check status on, is that correct?
[CUSTOMER][NEUTRAL] Uh, may I know how many claims can you assist over the call?
[AGENT][NEUTRAL] How many claims do you have, [PII]?
[CUSTOMER][NEUTRAL] Uh, I do have 9 more.
[AGENT][NEUTRAL] Yes ma'am, I can help you. Is it 9 different patients or is it the same patient with multiple dates of service?
[CUSTOMER][NEUTRAL] It's a different patients.
[AGENT][NEUTRAL] OK, so [PII], you first off you will use my name and today's date as your call reference number for each one.
[AGENT][NEUTRAL] Also, any information that I provide for you on any of the claims I check will be a verification of benefits and not a guarantee of payment.
[AGENT][NEUTRAL] And lastly, if you need a copy of any of the explanation of benefits for any of the claims, you may go to our portal to print those yourself and our portal website is secured.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you so much for this information. And for my documentation, could you please spell out your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and what is your first patient's policy number, [PII]?
[CUSTOMER][NEUTRAL] 02388965
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, one moment.
[AGENT][NEUTRAL] OK, [PII], are you there?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. So what is, I can now, what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Can you hear me?
[CUSTOMER][NEUTRAL] The first name I'll spell out is [PII]. Date of birth, [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] One moment please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Date of service is [PII]. And the charge amount is $10,530 even.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, [PII], so this claim was received.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Receive date was tonight on [PII].
[CUSTOMER][NEUTRAL] Uh, your voice is in and out. Could you please repeat that again?
[AGENT][NEUTRAL] Received 10-7-2024. Processed and denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3515767.
[AGENT][NEUTRAL] And the denial remark states the maximum benefits payable for this state of service has been met.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Is that this is denying for maximum level of payable has been met?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] The remark states the maximum benefit payable for this state of service has been met.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And is there any other information that you need on this number?
[CUSTOMER][NEUTRAL] Oh yes, one moment.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Is that the dollar amount?
[AGENT][POSITIVE] Yes, ma'am. It states the maximum benefit payable. That is correct.
[CUSTOMER][NEUTRAL] Or like.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] All right. And uh do you have any additional information on that? How many dollars?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] The maximum outpatient benefits per calendar day is $200 for covered outpatient services.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] All right. Thank you so much. And uh is that this met in uh the previous uh claim?
[AGENT][NEUTRAL] It was met on another claim that was received prior to your claim being received.
[CUSTOMER][NEUTRAL] The previous services?
[CUSTOMER][NEUTRAL] All right, one moment.
[CUSTOMER][NEUTRAL] Uh, for my documentation, are you able to help me with the claim number or any other information on that claim?
[AGENT][NEUTRAL] No, ma'am, I can't provide another provider's information to you. I gave you your claim number and the status of your claim.
[CUSTOMER][NEUTRAL] All right, thank you. And this, uh this is for uh.
[CUSTOMER][NEUTRAL] Will the patient be responsible for this?
[AGENT][NEUTRAL] We do not determine patient responsibility, that would be up to the provider.
[CUSTOMER][NEUTRAL] All right, one moment.
[CUSTOMER][POSITIVE] All right, thank you so much. And just allow me one quick moment. I just like to verify in my, in one moment.
[CUSTOMER][NEUTRAL] And are you able to fax a copy of COB?
[AGENT][NEUTRAL] I gave you our website if you're needing it since you have 9 claims, [PII], you can print them yourself by going to that portal website that I gave you.
[CUSTOMER][NEUTRAL] All right, one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] All right, thank you so much for patiently holding and one quick moment, I'll go to the next account.
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.