AccountId: 011433970860
ContactId: 81bbf580-687e-444d-940d-ce482a102055
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 363119 ms
Total Talk Time (AGENT): 137485 ms
Total Talk Time (CUSTOMER): 132787 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/81bbf580-687e-444d-940d-ce482a102055_20250506T20:39_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi this is [PII] from provider's office to check on a claim she is.
[AGENT][NEUTRAL] Sure, I can assist you with that. Can I have a callback number for you and can you repeat your name?
[CUSTOMER][NEUTRAL] Uh, my name is [PII]. It could be spelled as uh [PII] and my last name would be [PII], and the contact would be [PII] with no extension.
[AGENT][NEUTRAL] Thank you, [PII] and what is the policy number of the member that you're calling to verify benefits for?
[CUSTOMER][NEUTRAL] Um, yes, ma'am, I would be 02576516.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Is the patient's name would be [PII] and the date of birth is on [PII].
[AGENT][NEUTRAL] Thank you, [PII], you're calling to verify eligibility.
[CUSTOMER][NEUTRAL] Um, the claim status.
[AGENT][NEUTRAL] What is the data service that you're calling to check the status of a claim for?
[CUSTOMER][NEUTRAL] Uh, data on [PII].
[AGENT][NEUTRAL] And what is your procedure code?
[CUSTOMER][NEUTRAL] Um, the procedure code would be.
[CUSTOMER][NEUTRAL] It's 93,010 and uh 99289.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] This claim was received [PII]. It was processed.
[AGENT][NEUTRAL] Process [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] There was no payment made on this claim and the reason why there was no payment made on the claims are is because.
[AGENT][NEUTRAL] Benefits were maxed out for the date of service.
[CUSTOMER][NEUTRAL] I'm sorry. The reason again.
[AGENT][NEUTRAL] The benefits were maxed out for the date of service.
[CUSTOMER][NEUTRAL] Uh, uh, benefits.
[AGENT][NEUTRAL] We're maxed out for their date of service.
[CUSTOMER][NEUTRAL] Um, I couldn't able to get what you're, uh, seeing.
[AGENT][POSITIVE] The benefits were maxed out.
[AGENT][NEGATIVE] There was no payment made on the claim because the benefits were maxed out, the benefits were exhausted.
[CUSTOMER][MIXED] OK, benefits exhaustion.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] Um, benefits exhausted.
[AGENT][NEUTRAL] Would you like that claim number?
[CUSTOMER][NEUTRAL] Um, whether in terms of, uh, dollar or in terms of, uh, visit.
[AGENT][NEUTRAL] The dollar amount.
[CUSTOMER][NEUTRAL] Uh, what's the maximum product?
[AGENT][NEUTRAL] For the date of service.
[CUSTOMER][NEUTRAL] So it's a maximum dollar amount.
[AGENT][NEUTRAL] Well, the policy is terminated now, however, when the policy was active, the member had benefits amount of 150 $125 per visit.
[AGENT][NEUTRAL] With 5 visits per calendar year and this is not a guarantee of benefit it's just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] Uh, and 5 visits, uh, was covered during the year, right?
[AGENT][NEUTRAL] Yes, that is correct. 5 visits per calendar year.
[AGENT][NEUTRAL] If one visit is done, if one visit benefit were maxed out for the calendar day for Monday, then no other visits will be covered for that Monday.
[CUSTOMER][NEUTRAL] OK. And um
[CUSTOMER][NEUTRAL] With it on the date of service of [PII], uh, uh, which is
[AGENT][NEUTRAL] That is correct. I cannot discuss any other claims in regards to that data service besides your claim that you submitted due to HIPA. Are you familiar with HIPAA?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[CUSTOMER][POSITIVE] Thank you. And
[CUSTOMER][NEUTRAL] Yes, can I have the claim number?
[AGENT][NEUTRAL] The claim number is 3,558,480. That's 3,558,480.
[CUSTOMER][NEUTRAL] Thank you. And um can I have the claim receive date again?
[AGENT][NEUTRAL] The claim was received [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you. And the process date?
[AGENT][NEUTRAL] Same day.
[CUSTOMER][NEUTRAL] Same date. OK, thank you. And can I have the call reference number?
[AGENT][NEUTRAL] We don't provide those are, however, you can use my name in today's date as a reference. Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Could you please spell your name?
[AGENT][NEUTRAL] Of course, [PII].
[CUSTOMER][POSITIVE] OK, thank you so much and thank you for assisting me. And for this, could you be, uh, please fax me a copy of and you will be.
[AGENT][NEUTRAL] What is your fax number?
[CUSTOMER][NEUTRAL] Um, is the fax number be?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. Uh just to confirm, it is [PII] and the attention would be my name, [PII].
[AGENT][NEUTRAL] Alrighty [PII]. Is there anything else that I can assist you with before I end our call?
[CUSTOMER][POSITIVE] No, ma'am. Thank you. I got the required information and thank you so much for assisting me. Have a great day and bye.
[AGENT][POSITIVE] Thanks for calling APL. You have a great one as well, [PII]. Goodbye.
[CUSTOMER][POSITIVE] Thanks. Bye-bye.