AccountId: 011433970860
ContactId: 886d3b52-c511-439c-ab13-a6b2137f2543
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 460500 ms
Total Talk Time (AGENT): 102846 ms
Total Talk Time (CUSTOMER): 117286 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/886d3b52-c511-439c-ab13-a6b2137f2543_20250502T14:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I said I just need to check on the account status for a particular patient.
[AGENT][NEUTRAL] OK, I'm happy to check on the claim. What's the policy number?
[CUSTOMER][NEUTRAL] So I'm going to provide the policy number in just a second.
[CUSTOMER][POSITIVE] So right.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So it is going to be uh.
[CUSTOMER][NEUTRAL] Yeah, it's 1222.
[CUSTOMER][NEUTRAL] 156 M as in Mary, L as in Lima, and 8.
[AGENT][NEUTRAL] I apologize. I need you to start over. The phone cut out.
[CUSTOMER][NEUTRAL] Sure. It's 1343156, M as in Mary, L as in Lima, and 8.
[AGENT][NEUTRAL] Thank you. And for documentation, can I please get your first name again?
[CUSTOMER][NEUTRAL] So, it's [PII].
[AGENT][NEUTRAL] Thank you, [PII]. What's the patient name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] The last name is [PII], [PII] The first name is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] up with this.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEGATIVE] Gage service.
[CUSTOMER][NEUTRAL] Uh, it was also on the second. It's on [PII]. And the total bill amount is
[CUSTOMER][NEUTRAL] Um, it's $7000 375 point even.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][POSITIVE] Sure, take your time. No worries.
[AGENT][NEUTRAL] Alright, so it looks like we did receive this claim on [PII].
[AGENT][NEUTRAL] Claim was denied [PII]. The calendar year max for the outpatient benefit has been met, so there was nothing payable.
[CUSTOMER][NEUTRAL] May I, may I know the denied, denied this?
[AGENT][NEUTRAL] I'm sorry, what was that again?
[CUSTOMER][NEUTRAL] Uh, may I know the denied reason for this?
[AGENT][NEUTRAL] Outpatient calendar year max has been met.
[CUSTOMER][POSITIVE] Yes I can.
[CUSTOMER][NEUTRAL] Patient calendar year me right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] It makes a me
[CUSTOMER][NEUTRAL] Sir, can you hear me?
[AGENT][NEUTRAL] Mhm. Yes, the outpatient benefit max was 9.
[CUSTOMER][NEUTRAL] It, it
[CUSTOMER][NEUTRAL] Oh, tax, uh, patient benefit is max, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Patient benefit max.
[CUSTOMER][NEUTRAL] That's
[AGENT][NEUTRAL] Are you still there [PII]?
[CUSTOMER][NEUTRAL] Uh, sir, I just get the retail for the, just need from the primary UB. I just get the reail like primary U is needed.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] You need the EOB, is that what you're asking for?
[CUSTOMER][NEUTRAL] No, ma'am. I just get the email from your side that I just need, you just need a primary UV from us.
[AGENT][NEUTRAL] OK, so that was the original denial when the claim was first submitted. We did receive the other carriers EOB and then the claim was denied because the benefit max has been met.
[CUSTOMER][NEUTRAL] OK, just a second.
[CUSTOMER][NEUTRAL] Could you please send me the UP through fax?
[AGENT][NEUTRAL] Yeah, what's the fax number?
[CUSTOMER][NEUTRAL] And may I know whose responsibility it is?
[AGENT][NEUTRAL] I'm sorry, what was that again?
[CUSTOMER][NEUTRAL] Uh, who's responsibilities for patients or providers responsibility?
[AGENT][NEUTRAL] We don't advise on patient responsibility. That's up to the provider facility.
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] Uh, just a second, I'll go with the fax number.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Yeah, yeah, sure, sure, just a second, just looking.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, fax number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Just to confirm, [PII]?
[CUSTOMER][NEUTRAL] Yes, right.
[AGENT][NEUTRAL] Should we mark attention to anybody?
[CUSTOMER][NEUTRAL] That is my name and the date.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, my name is in the state.
[AGENT][NEUTRAL] Is there anything else I can do for you today?
[CUSTOMER][POSITIVE] Yeah, thank you for the information. May I also get the number for this?
[AGENT][NEUTRAL] Call references my name with my last initial than today's date. My name again is [PII], that's [PII], initial to my last name is [PII].
[CUSTOMER][POSITIVE] Yeah, thank you for that, sir.
[AGENT][POSITIVE] You're welcome, [PII]. Have a good day.
[CUSTOMER][NEUTRAL] Yeah, you too.