AccountId: 011433970860
ContactId: 8337ceea-ac70-45a5-98ec-44a31a801eb3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 507640 ms
Total Talk Time (AGENT): 77851 ms
Total Talk Time (CUSTOMER): 128275 ms
Interruptions: 1
Overall Sentiment: AGENT=2.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/8337ceea-ac70-45a5-98ec-44a31a801eb3_20250124T15:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey sir, my name is [PII] calling from provider office.
[AGENT][POSITIVE] How can I help today?
[CUSTOMER][NEUTRAL] Actually I have a claim. Can you please help me on that?
[AGENT][POSITIVE] Yeah, I'm happy to
[CUSTOMER][NEUTRAL] I want to know the purchase price.
[AGENT][POSITIVE] Yeah, I'm happy to check on a claim for you. What's the policy number?
[CUSTOMER][NEUTRAL] Policy number is 02049543.
[CUSTOMER][NEUTRAL] Are
[AGENT][NEUTRAL] And can I get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, sure, patient name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] And what's the data service?
[CUSTOMER][NEUTRAL] Date of service is [PII].
[AGENT][NEUTRAL] Spell them out.
[CUSTOMER][NEUTRAL] Bill amount is.
[CUSTOMER][NEUTRAL] Mm, let me confirm the bill amount as well. Just give me a second.
[CUSTOMER][NEUTRAL] The bill amount is.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] $369.25.
[AGENT][POSITIVE] Alright thank you one moment please.
[CUSTOMER][NEUTRAL] Hey.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Do you have an amount after the primary?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] It's $20.09.
[CUSTOMER][NEUTRAL] Let me confirm you as well.
[CUSTOMER][NEUTRAL] No, no. Just give me a second. I'll just confirm you as well.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's $41.76.
[AGENT][NEUTRAL] I don't show a claim on file for that amount.
[CUSTOMER][NEUTRAL] Actually, uh,
[CUSTOMER][NEUTRAL] I have a primary.
[AGENT][NEUTRAL] Do you have a claim number?
[CUSTOMER][NEUTRAL] Sure, I just provide you the new number as well. Just give me a second.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Should I speak the claim number?
[AGENT][NEUTRAL] Yeah, go ahead.
[CUSTOMER][NEUTRAL] OK number is 3539.
[CUSTOMER][NEUTRAL] 132.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, don't
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so this claim sent a benefit payment in the amount of $7.69.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Exactly and.
[CUSTOMER][NEUTRAL] This, uh, in this claim, the procedure code is 0431 has denied as benefit max reached.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, and I just want to know, we are billing as a 1 rental, and I just want to know the purchase price of this particular procedure code which is E0431.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] So the outpatient benefit max for the calendar year is 4500. The patient had already met that, so nothing additional was payable.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Can you please repeat that?
[AGENT][NEUTRAL] The outpatient benefit max is $4500.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 7119.
[AGENT][NEUTRAL] The patient had met this amount, so nothing additional was payable.
[CUSTOMER][NEGATIVE] So it's denied this.
[CUSTOMER][NEUTRAL] So, it's denied as outpatient patient has maximum this uh maximum reach, is reach.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] It's for outpatient, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] And can I get the call reference number for this call?
[AGENT][NEUTRAL] Call references my name with my last initial in today's date. My name is [PII], that's [PII] My last initial is [PII].
[CUSTOMER][NEUTRAL] And your name and today is, it's gonna be a call reference number, correct?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] He
[CUSTOMER][POSITIVE] Got it. Thanks, sir, for helping me in this claim. Have a good day. Bye-bye.
[AGENT][NEUTRAL] You too. Bye-bye, [PII].