AccountId: 011433970860
ContactId: 7f303906-e85a-49ff-900b-0c43e6a7efd0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 665849 ms
Total Talk Time (AGENT): 149123 ms
Total Talk Time (CUSTOMER): 124877 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/7f303906-e85a-49ff-900b-0c43e6a7efd0_20250528T19:44_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, my name is [PII]. I'm calling from Pros office to check on the claim status. Can you help with the status of the claim?
[AGENT][NEUTRAL] OK, I can help you with claim status, sir. May I please get your callback number just in case the call is disconnected?
[CUSTOMER][NEUTRAL] Sure. It's [PII]. It's a direct line, my extension.
[AGENT][POSITIVE] Thank you, yes.
[AGENT][NEUTRAL] OK, and then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] The policy number is 02107014 M as in Mary, L as in Lima 8 and the patient's name is uh [PII], and the date of birth would be
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, let me pull up that policy for us real quick.
[AGENT][NEUTRAL] Alright, and then can you please give me the data service and the charge amount?
[CUSTOMER][NEUTRAL] The service should be [PII] and the bill amount should be $1,708 even.
[AGENT][NEUTRAL] OK, and then what is the amount after the primary paid their part?
[CUSTOMER][NEUTRAL] $706.80.
[CUSTOMER][NEUTRAL] Actually, the
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Me, sorry, the primary forward to the deductible amount with the $706.80 and the, the bill $706.80 to secondary.
[AGENT][POSITIVE] OK, thank you so much. And then what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] It's Saint Lucy Anastasia Associates LLC.
[AGENT][NEUTRAL] OK, [PII], I'm gonna put you on a quick hold while I look up this claim for us and I'll be right back sir.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me, [PII]. So looking on data service of [PII], I do not find a claim on file.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Just a second.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] I will forward the claim number. It's uh 359-8971.
[AGENT][NEUTRAL] OK, let me look real quick.
[AGENT][NEUTRAL] Oh, that's why you gave me a different policy number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Different policy number.
[AGENT][NEUTRAL] Yeah, the policy number you gave me was 2107014 ML8 and then this policy number that the claim is on is 254-577-6.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me look real quick, sir.
[CUSTOMER][NEUTRAL] 254-577-6.
[AGENT][NEUTRAL] Yes, that's correct. That's, that's the claim that this policy is on this um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The policy number this claim is on.
[CUSTOMER][POSITIVE] Yeah, sorry, sorry for that.
[AGENT][NEUTRAL] That's that's fine at least we found it. OK, so this claim has been denied because the outpatient benefit for this calendar year has been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How much the benefits amount?
[CUSTOMER][NEUTRAL] The calendar year and so much.
[AGENT][NEUTRAL] Let me look for you.
[AGENT][NEUTRAL] I have to go to that policy number and look it up real quick.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] Give me just a minute while I pull it in, sir.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so the outpatient benefit, and this is just to verify benefits, it's not a guarantee payment per calendar year for outpatient was $1500.
[AGENT][NEUTRAL] And it already been met for this calendar or for that calendar year for [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the total $1500 is made by the patient, right?
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yes, that's already been met, yes sir.
[CUSTOMER][POSITIVE] OK. Thank you. Give me a second, ma'am.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Yes, hello, ma'am. Are you there?
[AGENT][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] Thanks for holding. Thanks for that. And uh ma'am, can you provide me the patient and the annual deductible amount?
[AGENT][NEUTRAL] The patient doesn't have a deductible amount.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] There's no deductible on this policy?
[CUSTOMER][POSITIVE] OK. Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The patient plan type.
[AGENT][NEUTRAL] Medlink
[CUSTOMER][NEUTRAL] Sorry, Ma link.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Like a HM or PPO like that.
[AGENT][NEUTRAL] No, it's none of those. It's a secondary.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] My link um, thank you and uh
[CUSTOMER][NEUTRAL] I know the call reference number?
[AGENT][NEUTRAL] Yes sir, you can use my name [PII] in today's date.
[CUSTOMER][POSITIVE] Thank you for that and uh have a nice day, ma'am. Take care.
[AGENT][POSITIVE] You too [PII] you have a good day also and thank you for calling APL you take care too.
[AGENT][NEUTRAL] Bye bye, sir.