AccountId: 011433970860
ContactId: 85bac486-1939-4b16-8362-8f527f575571
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 235929 ms
Total Talk Time (AGENT): 90247 ms
Total Talk Time (CUSTOMER): 91212 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/85bac486-1939-4b16-8362-8f527f575571_20250304T18:37_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from provider's office to check the claim status. Could you please help me?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Could I get a callback number for you, [PII]?
[CUSTOMER][NEUTRAL] Mhm. [PII].
[AGENT][NEUTRAL] You can call for status today.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] You call for status today?
[CUSTOMER][NEUTRAL] Yeah, claim status.
[AGENT][NEUTRAL] OK, I can help you with that. What is the policy number you're calling on?
[CUSTOMER][NEUTRAL] OK. 02520427.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name, [PII], and date of birth, [PII].
[AGENT][NEUTRAL] What is the data service you're checking?
[CUSTOMER][NEUTRAL] D of service [PII]. Total charge amount $660 even.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, I do show the claim uh received uh the claim was denied. It looks like they met the maximum physician visit, um, benefits for the calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. How many units allowed?
[AGENT][NEUTRAL] 5 a year.
[CUSTOMER][NEUTRAL] 5 units allowed, right?
[CUSTOMER][NEUTRAL] For the CPT, right?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] For a physician visit.
[CUSTOMER][NEUTRAL] For physician, OK.
[CUSTOMER][NEUTRAL] How many units, you needs completed?
[AGENT][NEGATIVE] It has been maxed out, ma'am. She had no more benefits allowed.
[CUSTOMER][NEUTRAL] OK. But upon checking, I didn't see any payments for this provider under this provider.
[AGENT][NEUTRAL] It's not for the provider, ma'am. It is for the service, a physician office or a physician visit.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] She has maxed out her physician visits for the calendar year and uh as a matter of fact, in fact, it is, uh, yes, it is the 5 visits a year.
[CUSTOMER][NEUTRAL] For service.
[CUSTOMER][NEUTRAL] For and.
[CUSTOMER][NEUTRAL] Per year, right?
[AGENT][NEUTRAL] Is there anything else I can, yes.
[CUSTOMER][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] But upon checking under this position, only one claim was billed.
[AGENT][POSITIVE] Oh my gosh.
[AGENT][NEUTRAL] Ma'am, it is not by physician. It is not by physician. It is by service. So she was seen by other physicians. She has maxed out this benefit for the calendar year.
[CUSTOMER][NEUTRAL] There is no other claim also.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] OK, can you provide the referring claim number?
[AGENT][NEUTRAL] The reference number?
[CUSTOMER][NEUTRAL] Referring claim number?
[AGENT][NEUTRAL] Claim number is 3557089.
[CUSTOMER][NEUTRAL] OK. May I know what is your name?
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] Lo Lo.
[CUSTOMER][NEUTRAL] Can I get the call reference number?
[AGENT][NEUTRAL] To reference the call you'll use my name and today's date.
[CUSTOMER][POSITIVE] OK. Thank you for your assistance. Have a nice day. Bye-bye.
[AGENT][POSITIVE] You're welcome. You have a wonderful day. Thank you for calling APL. Bye bye.