AccountId: 011433970860
ContactId: 8061b2ec-5d24-4f62-8f30-ba1eca18642a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 419609 ms
Total Talk Time (AGENT): 94727 ms
Total Talk Time (CUSTOMER): 135741 ms
Interruptions: 4
Overall Sentiment: AGENT=1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/8061b2ec-5d24-4f62-8f30-ba1eca18642a_20250304T15:32_UTC.wav
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[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, my name is [PII], and I'm sorry, you said your name is?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh [PII], I just spoke to you. Sorry.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Well, [PII], I have another patient. I just wanted to check the status of a claim.
[AGENT][NEUTRAL] OK, I can help you with the claim, [PII]. uh, can you please give me your callback number?
[CUSTOMER][NEUTRAL] How can I help you?
[CUSTOMER][NEUTRAL] Can you please give me
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] Thank you sir and then what's the patient's name, date of birth, and policy number?
[CUSTOMER][POSITIVE] Thank you for calling.
[CUSTOMER][NEUTRAL] Yes. The patient's first name is [PII], the last name is [PII]. Date of birth of [PII]. And the policy number is 018.
[CUSTOMER][NEUTRAL] 38933.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] OK and then what is the data service and the charge amount?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the total bill amount of $212.16.
[AGENT][NEUTRAL] OK, and then what is the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] $24.51.
[AGENT][NEUTRAL] Thank you, sir. And then can you give me the name of the facility?
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] This is for East Lake Medical LLC.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold [PII] while I look up this claim and I'll be right back.
[CUSTOMER][NEUTRAL] Sure, sure.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, [PII]. I've got the claim for you.
[CUSTOMER][POSITIVE] Thank you for holding for me [PII]. that's a claim for you. Mhm.
[AGENT][NEUTRAL] It's claim number 350.
[CUSTOMER][NEUTRAL] 350.
[AGENT][NEUTRAL] 2874.
[AGENT][NEUTRAL] We received the claim on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And process the claim on [PII].
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] 2024
[AGENT][NEUTRAL] And the claim was denied because the outpatient benefits for the calendar year have been met.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Give me one moment.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] Outpatient.
[CUSTOMER][NEUTRAL] And may I know the what what is the outpatient benefit for this patient?
[AGENT][NEUTRAL] They get.
[AGENT][NEUTRAL] Let me look.
[AGENT][NEUTRAL] They get $3000 per calendar year to go towards deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] deductible.
[AGENT][NEUTRAL] And that's just to verify benefits, it's not a guarantee of payment.
[CUSTOMER][NEUTRAL] A specific it's supposed to get.
[CUSTOMER][NEUTRAL] Got you. So which means for any outpatient services patient will be covered on maximum up to $3000 per calendar year.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Go.
[CUSTOMER][NEUTRAL] Alright, and when last the patient have uh met the $3000?
[AGENT][NEUTRAL] They met in in [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got you.
[CUSTOMER][NEUTRAL] Any
[CUSTOMER][NEUTRAL] Let me check and it's for a different provider that was being satisfied right? if I'm not wrong.
[AGENT][NEUTRAL] Right, I can't give the provider information.
[CUSTOMER][NEUTRAL] Uh, I don't know. I don't need, I just wanted to double check because I don't show that we have ever seen this patient prior to August, so just wanna make sure that's it.
[AGENT][POSITIVE] Yes, sir. Yes, sir. You're correct.
[CUSTOMER][POSITIVE] Yes sir, yes sir. Got you.
[CUSTOMER][NEUTRAL] Alright then, uh, can you help me with the call reference number please?
[AGENT][NEUTRAL] Yes sir, you can use my name [PII] and today's date.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] Alright, [PII], thanks for your time. You have a wonderful day.
[AGENT][POSITIVE] You too, [PII], you have a blessed one thanks for calling APL.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye-bye, sir.