AccountId: 011433970860
ContactId: 7ad21478-6ecf-4457-9385-d29293d397ab
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 537770 ms
Total Talk Time (AGENT): 92709 ms
Total Talk Time (CUSTOMER): 138996 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/7ad21478-6ecf-4457-9385-d29293d397ab_20250423T16:30_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good day. My name is [PII]. Last name initial is [PII] I am calling from Laboratory Corporation of America. This line will be recorded for training and quality purposes, and I'm calling to confirm if you have received the claim that we have submitted for one of our mutual patients. Can you please help me with this?
[AGENT][NEUTRAL] Yes, I can help you with the claim status. Can you please give me your contact number, ma'am, just in case our call is disconnected.
[CUSTOMER][NEUTRAL] Yeah, sure. Our callback number is [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Name is [PII]. The date of birth is [PII], and the policy number is 02221656 M. for Mary L for Lima 8.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And may I get the data er.
[AGENT][NEUTRAL] Now
[CUSTOMER][NEUTRAL] Um, the date of service is [PII], and the bill amount is $846.30.
[AGENT][NEUTRAL] OK, and then what are the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Just a moment. Let me go ahead and check that one here.
[CUSTOMER][NEUTRAL] Oh, for this one, there is no payment from the primary insurance.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And um, can you give me the name of your facility? Just one more time, please.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] It's Laboratory Corporation of America.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold, Ms [PII]. I'm going to look up this claim for us and I'll be right back.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 6
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] There it is 3542984.
[AGENT][NEUTRAL] Thank you for holding for me. I did find the claim, uh, the claim number is 354.
[AGENT][NEUTRAL] 2984.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim was denied because the um benefit has been maxed for the calendar year for outpatient.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sorry, just a moment.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Mhm, is there any patient responsibility for this one?
[AGENT][NEUTRAL] We do give patient responsibility that is determined by the provider.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] So to confirm, the claim was denied due to benefit um benefit maximum has been exceeded for the calendar year for the outpatient, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And uh the patient responsibility is provided by the provider, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mhm, so basically there is no patient responsibility on your end, correct?
[AGENT][NEGATIVE] Uh, we don't give patient responsibility at all.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Alright, no worries, I'll take note of this one.
[CUSTOMER][NEUTRAL] For documentation purposes, sorry, may I have your last name initial as well as the call reference number for this claim?
[AGENT][NEUTRAL] Yes ma'am, you can use my name [PII], it's [PII]
[AGENT][NEUTRAL] And my last initial is [PII] and today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Alright, thank you [PII] and I think that would be all. I appreciate you for taking the time to answer my call and helping me with this matter. Again, this is [PII] and have a great day. Thank you. Bye for now.
[AGENT][POSITIVE] You're welcome, Ms. [PII]. You have a wonderful day too, and thank you for calling APL. Bye-bye.