AccountId: 011433970860
ContactId: 81e8f083-2413-42ef-b206-4fd6ab7c0d30
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 278119 ms
Total Talk Time (AGENT): 94970 ms
Total Talk Time (CUSTOMER): 116883 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/81e8f083-2413-42ef-b206-4fd6ab7c0d30_20250212T19:52_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] calling from the provider's office, checking on the claim status and uh.
[AGENT][NEUTRAL] OK, I can verify a claim status for you, [PII]. And what is the policy number, please?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sure, the policy number is, just give me a moment and before that, uh, can you spell your name for me once for the documentation?
[AGENT][NEUTRAL] Sure, it's [PII].
[CUSTOMER][POSITIVE] OK, thanks for that and um policy number is.
[CUSTOMER][NEUTRAL] 018
[CUSTOMER][NEUTRAL] 96036. M as in Mary, L as in Lima, and number 8.
[AGENT][POSITIVE] OK, thank you so much. And what is a good callback number, [PII], in case the call drops?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the extension.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And verify the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient's first name is.
[CUSTOMER][NEUTRAL] [PII] and the last name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, and what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] Yeah, the data service is on [PII], sorry, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the charge amount is $2600 yeah, it's $2610 even.
[AGENT][NEUTRAL] And the amount of the charge?
[AGENT][NEUTRAL] And do you have the balance after primary insurance is processed the claim?
[CUSTOMER][NEUTRAL] Yeah, it's uh $285 even.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And while I'm looking at claim information, just to let you know we do have an online service center where providers can check claim status as well as print out the EOB. That site is at secured. AM as in [PII], and you are calling from?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm calling from Gastro Health LLC.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sorry, it's, uh, we have anesthesia associates. Sorry for that.
[AGENT][NEUTRAL] Oh, you're fine. Give me one moment.
[CUSTOMER][NEUTRAL] It's yeah, yeah.
[AGENT][NEUTRAL] OK, I show that claim process is the outpatient benefit has maxed for the calendar year.
[CUSTOMER][NEUTRAL] OK, so what's the claim number for this one?
[AGENT][NEUTRAL] 3506454.
[CUSTOMER][NEUTRAL] OK, so what's the exact reason like the patient benefits has been maximum.
[AGENT][NEUTRAL] Yes, their outpatient benefits have maxed for the calendar year.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] OK, so how's the maximum patient benefits for the calendar year?
[AGENT][NEUTRAL] Uh, the patient has
[CUSTOMER][NEUTRAL] Like is it units or the visits?
[AGENT][NEUTRAL] The insured has a benefit max of up to 500 per calendar year, and they've already met that max.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So may I know that when he made that last dollar and to which claim uh is it with the same provider or not? I just want to check that one.
[AGENT][NEUTRAL] No, I can't give you that information. It's not from the same provider, so no, I can't get that.
[CUSTOMER][NEUTRAL] So I just want the date like when he met the last order.
[AGENT][NEUTRAL] I cannot give you that information.
[CUSTOMER][NEUTRAL] OK, just give me a moment, let me verify here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, thanks for that and may I know the exact date, like when the payment has been processed?
[AGENT][NEUTRAL] Uh, claim process on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thanks for that and thanks for assistance and I just want the call reference number for this one.
[AGENT][NEUTRAL] Uh, we don't give reference numbers, but you may use my name in today's date.
[CUSTOMER][POSITIVE] OK, thanks for that and thanks for your assistance and have a great day ahead.
[AGENT][POSITIVE] Alright, you're welcome. Thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Yeah, you too. Bye bye.