AccountId: 011433970860
ContactId: 85a47aa0-466b-4c4d-9561-f135d4a756ae
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 301309 ms
Total Talk Time (AGENT): 79529 ms
Total Talk Time (CUSTOMER): 79277 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/85a47aa0-466b-4c4d-9561-f135d4a756ae_20250612T19:35_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I'm calling for the doctor's office to check on the claim status.
[AGENT][NEUTRAL] OK, I can verify claim status for you, [PII]. And what is the policy number, please?
[CUSTOMER][NEUTRAL] Yes, give me one moment.
[CUSTOMER][NEUTRAL] Just one moment, pulling up.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah, that is 02538147.
[AGENT][POSITIVE] OK, thank you so much. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, that is [PII] and that's a direct line.
[AGENT][NEUTRAL] OK, and the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Date of birth
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oh, he has birthday tomorrow. And what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] Yes, state of service is [PII] and the total charges is for $11,149 even.
[AGENT][NEUTRAL] OK, and what was the balance after primary process the claim?
[CUSTOMER][NEUTRAL] Let me check that.
[CUSTOMER][NEUTRAL] I do show the balance uh is for $50 even after the uh I mean, primary process.
[AGENT][NEUTRAL] After primary process is $50 and what's the name of the provider's office?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] That is Adventist Health Glendale.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] I show the claim paid 250, which maxed out the benefit for the data service.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this claim processed on, give me a moment.
[AGENT][NEUTRAL] Uh, show that it was processed on [PII] of this year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I get the claim number?
[AGENT][NEUTRAL] Sure, 3554734.
[CUSTOMER][NEUTRAL] OK. Any denial on the claim?
[AGENT][NEUTRAL] As I stated, we paid $250 and with that payment, it matched their benefit for the data service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. May I know, uh, I mean,
[CUSTOMER][NEUTRAL] Oh, that is the allowed amount, uh, for the, allowed units for the current year, I mean, the calendar year.
[AGENT][NEUTRAL] That's the max payable, that's the max payable per day for outpatient services.
[CUSTOMER][NEUTRAL] 250
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Just 250 units were allowed per year. Am I correct?
[AGENT][NEUTRAL] Up to $250 was allowed per calendar year for outpatient, correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And may I get your call reference number?
[AGENT][NEUTRAL] Uh, if you like, you may use my name at today's date. And is there anything else, [PII], I can assist you with today?
[CUSTOMER][POSITIVE] Uh, no, that's it for the day. Thank you. Thank you so much for providing all those information. You have a nice day. Take care. Bye for now.
[AGENT][POSITIVE] Alright you too thanks for calling APL bye.