AccountId: 011433970860
ContactId: 7f07eaaa-5565-4824-b84b-65e45a6146c7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 883179 ms
Total Talk Time (AGENT): 133753 ms
Total Talk Time (CUSTOMER): 431710 ms
Interruptions: 5
Overall Sentiment: AGENT=0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/7f07eaaa-5565-4824-b84b-65e45a6146c7_20250617T20:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from provider office to check on claim status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] The policy number of the patient?
[CUSTOMER][NEUTRAL] Yeah, one moment.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] One moment, please.
[CUSTOMER][NEUTRAL] Please.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] 02249239.
[CUSTOMER][NEUTRAL] you do
[CUSTOMER][NEUTRAL] Colonel.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh patient name and date of birth?
[CUSTOMER][NEUTRAL] Mm, uh, the name, uh, first name is [PII], and uh last name is um [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And so I think.
[CUSTOMER][NEUTRAL] I just corporation.
[AGENT][NEUTRAL] And the date of service and bill charges?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] And the date of service is uh [PII] and the bill amount is $2,256.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] It was received on [PII], process [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The maximum amount payable for the occurrence has been met.
[AGENT][NEUTRAL] Dollar amount?
[CUSTOMER][NEUTRAL] Sorry, sorry?
[AGENT][NEUTRAL] Maximum amount payable for the occurrence has been met.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Denied.
[AGENT][NEUTRAL] The dollar amount?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Can you provide me the process date?
[AGENT][NEUTRAL] The claim was received on [PII], process [PII].
[CUSTOMER][NEUTRAL] Are they.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] There
[CUSTOMER][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Can you continue?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, what, what else did you need?
[CUSTOMER][NEUTRAL] Uh, yeah, OK. Continue.
[AGENT][NEUTRAL] You need the denial reason?
[CUSTOMER][NEUTRAL] Yeah. Can you provide me the denial reason?
[AGENT][NEUTRAL] Maximum benefit amount payable for this occurrence has been met.
[AGENT][NEUTRAL] The dollar amount?
[CUSTOMER][NEUTRAL] OK. OK, one moment.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Maximum benefits met patient.
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] You're needing to check claim status on the next patient or?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, one moment. Can I
[CUSTOMER][NEUTRAL] Uh, which benefits met?
[AGENT][NEUTRAL] It's a per occurrence treatment for the same related condition unless separated by a period of 90 days.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the maximum amount payable for this occurrence has been met.
[CUSTOMER][NEUTRAL] Do you need to.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Uh, for the visits or units or dollar.
[AGENT][NEUTRAL] It's a dollar amount.
[CUSTOMER][NEUTRAL] OK. Can you provide me the amount?
[AGENT][NEUTRAL] It's 500 per occurrence.
[CUSTOMER][NEUTRAL] 500.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What did you do
[CUSTOMER][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Uh, 500 is met, right?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Which date of service?
[AGENT][NEUTRAL] Uh, do you have a date of service you'd like to check on? I can do claim status for dates of service you're checking on.
[AGENT][NEUTRAL] Because they've got several dates on file, so.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So it pays 500.
[CUSTOMER][NEUTRAL] Actually,
[AGENT][NEUTRAL] In a 90 day period for per occurrence.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Uh, which date of service, um, uh, patient was met?
[AGENT][NEUTRAL] I can only provide claim status on claims you're asking about. So do you have a date of service you're asking about?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I am asking a patient was, uh, met was $500 right? So which date of service he met?
[AGENT][NEUTRAL] There are several claims on here, so there's several claims for several different dates of service in a ninety-day period.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Do you need me to send you the EOB?
[CUSTOMER][NEUTRAL] 90 days period. OK, one moment.
[CUSTOMER][NEUTRAL] 90. OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Do you have any other claim statuses?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yes, I have. OK, could you provide me the this call reference number and the claim number?
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] 359-9208 for reference is my name, [PII] and today's date.
[CUSTOMER][NEUTRAL] One moment. Claim number?
[CUSTOMER][NEUTRAL] Can you repeat one's claim number?
[AGENT][NEUTRAL] 3599208.
[CUSTOMER][NEUTRAL] 20. OK. uh call reference number?
[AGENT][NEUTRAL] My name and today's date?
[CUSTOMER][NEUTRAL] OK, spell your name, please?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK. Thank you.
[CUSTOMER][NEUTRAL] Um, one moment, I will provide you another claim.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh.
[CUSTOMER][NEUTRAL] Are you ready?
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Um, that is I1 Q as in
[CUSTOMER][NEUTRAL] Uh, Queen, U as in umbrella, 4, P as in Papa, 16 P as in Papa. F as [PII].
[AGENT][NEUTRAL] Um, that's not one of our policy numbers. And the last name?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, one moment. I will provide you another.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Oh, for for.
[CUSTOMER][NEUTRAL] Um, upon checking,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. I have another uh patient. I will provide you the number details.
[CUSTOMER][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 5.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Actually, I'm now I provided that is our uh one of the commercial uh account.
[AGENT][NEUTRAL] Sorry?
[CUSTOMER][NEUTRAL] OK. Can you, can I?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK. Uh.
[CUSTOMER][NEUTRAL] Can you check with that 140851678?
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Is this the policy number?
[CUSTOMER][NEUTRAL] Uh, member ID.
[AGENT][NEUTRAL] Um, it's, it's too long, the digits are too many. Do you have the last name of the patient?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah. Uh, K as in Kilo, I as in ice cream, T as in Tango, T as in Tango, [PII] in yellow, and the last name is [PII].
[CUSTOMER][NEUTRAL] But.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Not pulling up that name in our system.
[CUSTOMER][NEUTRAL] No, OK. Uh, can you pro uh, can you check with that? I have uh provide another, uh, can you check that patient, uh, last name and first name, OK?
[CUSTOMER][NEUTRAL] Already previously provided.
[CUSTOMER][NEUTRAL] This is the last one. Can you check with that patient uh last name and first name?
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] OK, the last name?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Hm. The patient name is uh [PII], and the last name is [PII].
[CUSTOMER][NEUTRAL] you
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] I don't do that
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] that.
[AGENT][NEUTRAL] I'm not pulling up that name in our system.
[CUSTOMER][POSITIVE] Oh, OK. Thank you. Thanks for uh providing me this information. Have a nice day. Bye-bye.
[AGENT][NEUTRAL] For calling APL you as well. Bye bye.