AccountId: 011433970860
ContactId: 7bda6332-e386-4c60-af37-5ee9c79cc1e8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 680719 ms
Total Talk Time (AGENT): 203808 ms
Total Talk Time (CUSTOMER): 182128 ms
Interruptions: 3
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/7bda6332-e386-4c60-af37-5ee9c79cc1e8_20250228T20:19_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 [PII], this is [PII] from Pror's office calling for claim status.
[AGENT][NEUTRAL] OK, [PII], you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that, [PII] and what is your callback number?
[CUSTOMER][POSITIVE] Thank you, it's [PII].
[CUSTOMER][NEUTRAL] [PII] is a direct line.
[AGENT][NEUTRAL] Thank you. And how many claims [PII], do you have to check status on?
[CUSTOMER][NEUTRAL] Only 12 claims.
[AGENT][NEUTRAL] OK, are they for two different patients?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. So yes, I can help you with both of those, [PII], and you will use my name that I gave you along with today's date as your call reference number.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK, thank you for that.
[AGENT][NEUTRAL] Also, any information you're welcome. Uh, any information that I provide for you on the claims will be a verification of benefits and not a guarantee of payment. And lastly, [PII], if we do have the claim on file and you need a copy of the primary or excuse me, need a copy of our explanation of benefits, you may print that by going to our portal which is located at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] You're welcome. And what is your first patient's policy number?
[CUSTOMER][NEUTRAL] The policy number is 021.
[CUSTOMER][NEUTRAL] 53544
[AGENT][NEUTRAL] I'm sorry, 53.
[CUSTOMER][NEUTRAL] 544, then M as in Mike, L as in Lima 7.
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Patient's name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I have the claim number if you need it.
[AGENT][NEUTRAL] What is the data service and total bill amount?
[CUSTOMER][NEUTRAL] It's December 27 of 24.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Total bill is $714 even 714.
[AGENT][NEUTRAL] OK, thank you, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and the claim number it should be 356-464-6, is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][POSITIVE] OK, how can I help you with that?
[CUSTOMER][NEUTRAL] So the claim has been denied for uh the patient is inactive for the date of service on your, on your insurance. So can you provide me the eligibility date for the patient?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The effective date of this policy had been [PII].
[AGENT][NEUTRAL] 3
[CUSTOMER][NEUTRAL] Sorry, your voice has been cut out. 23, right?
[AGENT][NEUTRAL] And the term date is, I'm sorry. No, let me start over. The effective date is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the term date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, got you. Thank you for that information.
[CUSTOMER][NEUTRAL] Mm just a second.
[AGENT][NEUTRAL] Was there any other information? Uh-huh.
[CUSTOMER][NEUTRAL] Uh, no, that's it for today. Uh, so, so that's it for this claim. Thank you for the information.
[AGENT][NEUTRAL] OK, so give me just one moment to get the work and pull the other one up.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] I mean that patient policy number?
[CUSTOMER][NEUTRAL] Yes, I'll provide that one second. The next member eligibility is, uh sorry, the policy number is 022.
[AGENT][NEUTRAL] I'm sorry, say, I'm sorry. Start over with the policy number, [PII].
[CUSTOMER][NEUTRAL] Yeah, it's
[CUSTOMER][NEUTRAL] OK. 022.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 216
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 56
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is
[CUSTOMER][NEUTRAL] And it's
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I'll spell that name.
[AGENT][NEUTRAL] That's OK. What's the date, you don't have to spell that. What is the, what the date of birth? I'm sorry.
[CUSTOMER][NEUTRAL] One second. Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, just a second. I'll provide that.
[CUSTOMER][NEUTRAL] 7966.
[CUSTOMER][NEUTRAL] Yeah. Uh, the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount please.
[CUSTOMER][NEUTRAL] Date of service is [PII].
[CUSTOMER][NEGATIVE] And total bill is $671 even.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and do you already have the claim number for this one?
[CUSTOMER][NEUTRAL] Yes, it's 356-526-8, right?
[AGENT][NEUTRAL] Yes, sir. It is. And how can I help you with this claim?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Claim has been denied for outpatient benefit for this calendar has been met. So can you provide me on which term the maximum benefit has been met?
[AGENT][NEUTRAL] Just one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, just one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, so the it was met on another claim that was received for prior to yours for 10-15 data service.
[AGENT][NEUTRAL] But I can't provide you another provider's information regarding details on the claim.
[AGENT][NEUTRAL] It was satisfied with the claim received prior to your claim.
[CUSTOMER][NEUTRAL] OK, not an issue. Uh, just provide me, can you provide me how many benefits for this calendar has been met, on which time it is? Outpatient benefits?
[CUSTOMER][NEUTRAL] How many were allowed to the patient for calendar year?
[AGENT][NEUTRAL] The outpatient benefit max per calendar year for covered outpatient services is $3500 with no outpatient deductible. Yes sir, that is correct.
[CUSTOMER][NEUTRAL] $3500.
[CUSTOMER][NEUTRAL] Without
[CUSTOMER][NEUTRAL] Patient this one already, right?
[AGENT][NEUTRAL] I'm
[AGENT][NEUTRAL] We do not determine patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. So outpatient minimum max was for the patient was 3500, right? Which was met last time?
[AGENT][NEUTRAL] A claim that was processed prior to yours being received.
[CUSTOMER][NEUTRAL] Uh, do you have any date of service or the claim number if under our provider?
[AGENT][NEUTRAL] No, sir. I can't, it is not related to your provider, so I'm not able to provide that information.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, uh, not, not at the date of service also. You can provide me the date of service.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, of [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And a different provider, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And the and the claim number and call reference will be the same, right?
[AGENT][NEUTRAL] The call reference number that, yes.
[AGENT][NEUTRAL] And you already have the claim number. Yes, sir.
[CUSTOMER][NEUTRAL] Will be same.
[CUSTOMER][POSITIVE] Uh yes, I have that. Thank you for the, so thanks for your assistance, [PII]. Have a nice day. Bye-bye.
[AGENT][POSITIVE] You're welcome. Yes, I hope you do too. That's all I can help you with. Thank you again for calling APL.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Uh-huh. Bye-bye.