AccountId: 011433970860
ContactId: 82cb8631-2209-4854-b46a-9d1f998cf46e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 590590 ms
Total Talk Time (AGENT): 140947 ms
Total Talk Time (CUSTOMER): 149608 ms
Interruptions: 6
Overall Sentiment: AGENT=2.3, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/82cb8631-2209-4854-b46a-9d1f998cf46e_20250325T13:51_UTC.wav
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[AGENT][POSITIVE] Good morning and thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, so my name is [PII] and I'm just making sure you have a claim on file and if there's any movement on it at all.
[AGENT][NEUTRAL] OK, sure. I can assist you with claims, Ms. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] That dear [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yep, it is 02449767.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] You bet it's [PII] [PII].
[AGENT][NEUTRAL] Thank you and what is the date of service and the amount of the claim?
[CUSTOMER][NEGATIVE] It is [PII] and our bill amount is um sorry I gotta look because they screwed up the claim so many times here um.
[CUSTOMER][NEUTRAL] I've got $107,497.
[CUSTOMER][NEUTRAL] McDonald's, yup.
[AGENT][NEUTRAL] OK, I think it's this one. Let me pull it'll be.
[CUSTOMER][POSITIVE] Bye bye. Well, take your time.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] I'm waiting on the EOB to upload. OK, thank you.
[CUSTOMER][NEUTRAL] Oh, you're fine dear you're fine.
[AGENT][NEUTRAL] OK, we processed the claim on [PII].
[AGENT][NEUTRAL] And um the claim was denied. The reason for this denial is that
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The outpatient benefits for the calendar year has been met.
[CUSTOMER][NEUTRAL] So the patient maxed out their benefits?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh OK, probably with other claims I'm guessing.
[CUSTOMER][NEUTRAL] OK, yep, I see her note here says the max is 2000 net zero.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, so we are able to bill the patient then because the primary it's uh coinsurance that they're billing.
[AGENT][NEUTRAL] Mhm. Yeah, it, it's up to the provider's discretion. We don't have any contractual vomit on the remaining um after we process, but yeah, that's how it usually goes.
[CUSTOMER][NEUTRAL] OK. OK. Um.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um, I don't think we've got a copy of the explanation of benefits. Are you able to fax that?
[AGENT][NEUTRAL] Yes, sure. Um, what is that um fax number?
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][NEUTRAL] Um, fax number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. [PII] to your attention.
[CUSTOMER][POSITIVE] That's right.
[CUSTOMER][POSITIVE] Yeah, that'd be awesome.
[AGENT][NEUTRAL] OK, let me go ahead and do that. Do you mind holding for me while I send it right now?
[CUSTOMER][POSITIVE] You're fine, dear. No, I am super patient.
[AGENT][NEUTRAL] OK
[AGENT][POSITIVE] Thank you. I'm glad you are. Thank you so much. One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, not a lot of people are, but when I have a friendly voice on the other end, I am even more patient, so thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] You're welcome. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for Miss [PII].
[CUSTOMER][NEUTRAL] Oh, so I'm glad you came back on. I gave you the number wrong. It's 813-603. I am so sorry. I'm sitting here thinking, oh my [PII], I told her the wrong number.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Hey
[AGENT][NEUTRAL] Oh, it's OK. Uh, you said.
[CUSTOMER][NEUTRAL] You know how you take a few days off and then you forget everything, yeah, that's me.
[AGENT][NEUTRAL] Oh, yes. Yeah, that's me too.
[CUSTOMER][NEUTRAL] Forget my own number.
[CUSTOMER][NEUTRAL] I'm sorry, hon.
[AGENT][NEUTRAL] I don't, no worries. Um, now the fax number you did give me the [PII] for the fax number, the phone number was the one that was.
[CUSTOMER][NEUTRAL] Yeah [PII]. 0 my goodness.
[AGENT][POSITIVE] Yeah, OK, so that one was good.
[CUSTOMER][NEUTRAL] I'm slapping my forehead for you.
[AGENT][POSITIVE] It's OK, I understand. Yeah, the fax number was correct, so it did go to the right fax number, so that's a good thing, um, and it should be there in a few minutes. If, if you don't get it within like 15 minutes, just give us a call back and we can resend it, but it should be there by then.
[CUSTOMER][POSITIVE] Oh goodness.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, you're so sweet.
[AGENT][POSITIVE] You're welcome. No problem, no problem. It's OK. I understand 100%. You as well, Miss [PII], and thank you for calling API.
[CUSTOMER][POSITIVE] So sweet. Thank you.
[CUSTOMER][POSITIVE] Thank you, dear. You have a good week.
[CUSTOMER][NEGATIVE] I know, it's so hard to be human.
[CUSTOMER][POSITIVE] Thank you. You're so sweet. I appreciate that so much. Thank you. Take care. All right. Bye-bye. Thank you.
[AGENT][POSITIVE] You're welcome. You're welcome. You're welcome. Have a good day. Bye-bye.