AccountId: 011433970860
ContactId: 8f120fd5-a5ee-4706-8c3f-54418e508286
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 449880 ms
Total Talk Time (AGENT): 149661 ms
Total Talk Time (CUSTOMER): 100453 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/8f120fd5-a5ee-4706-8c3f-54418e508286_20250414T14:11_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello. Yes, I can hear you now. I, I.
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] I'm audible?
[AGENT][NEUTRAL] Yes, I can hear you now. I can't hear you before.
[CUSTOMER][NEUTRAL] Yeah, OK. My name is [PII] calling from provider office checking on claim status.
[AGENT][NEUTRAL] OK, well I can definitely help you with the claim status [PII], and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Can you repeat again?
[AGENT][POSITIVE] Sure, I'll be more than happy to help you with the claims today. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Yeah, I have only one client.
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Thank you. May I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's 1330836. M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah. My first name is [PII] and the last name is [PII]. It's [PII]
[AGENT][NEUTRAL] OK, and the date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the total, I'm sorry, may I have the date of service for the claim and the total bill?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] The total charge amount is $468 even.
[AGENT][POSITIVE] Thank you for that. Hold on one moment.
[AGENT][NEUTRAL] And again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yeah, it's separate Hospital, Troy parent location.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] So I'm showing we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 353.
[AGENT][NEUTRAL] 5212.
[AGENT][NEUTRAL] And on [PII], the claim was denied because the outpatient benefit for this calendar year has been met.
[CUSTOMER][NEUTRAL] Can you repeat again the?
[AGENT][NEUTRAL] Yes, the um calendar year max has been met.
[CUSTOMER][NEUTRAL] May I know the dinner date?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] It was denied on [PII].
[CUSTOMER][NEUTRAL] Yeah, just a moment.
[CUSTOMER][NEUTRAL] Sorry for asking. Can you repeat again the denied reason?
[AGENT][NEUTRAL] The calendar year max has been met.
[CUSTOMER][NEUTRAL] Yeah, just a moment.
[CUSTOMER][NEUTRAL] Yeah, I did not receive any UOB. Can you please fax through the UOB?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] And would that be attention, [PII]?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII].
[AGENT][NEUTRAL] And that was 248.
[CUSTOMER][NEUTRAL] You can use the attention.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] You can use the, use my name for that.
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][POSITIVE] Yeah, it's right.
[AGENT][POSITIVE] All right, so I'll go ahead and fax the explanation of benefits over to you now. Was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Yeah, how much time it will take?
[AGENT][POSITIVE] Um, for a fax, we usually say to give it at least an hour. If you have not received it by end of day today, just let us know, we'll be more than happy to resend it for you.
[CUSTOMER][NEUTRAL] OK. May I have the call reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. Again, that's [PII], first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Yeah, just a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, ma'am.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] May I know the denied code?
[AGENT][NEUTRAL] The denial code as in the code that's on the explanation of benefits like that we use to deny.
[CUSTOMER][NEUTRAL] Yeah, the net code, I want.
[AGENT][NEUTRAL] OK. Hold on one second.
[AGENT][NEUTRAL] D as in dog, the number 2, M like Mary, 0306.
[CUSTOMER][NEUTRAL] Yeah, sorry for asking. Can you please spell me the reason because I write a note.
[AGENT][NEUTRAL] The calendar year maximum?
[CUSTOMER][NEUTRAL] Say
[AGENT][NEUTRAL] For outpatient expenses has been met.
[CUSTOMER][NEUTRAL] Isn't it?
[CUSTOMER][POSITIVE] Yeah, thank you. That's it. Thank you for assisting me. Have a great day.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, nothing. That's it. Thank you for assisting me. That's it.
[AGENT][POSITIVE] All right, well, thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Yeah, thank you, bye.
[AGENT][NEUTRAL] Bye bye.