AccountId: 011433970860
ContactId: 8fb84c11-def3-460b-85ea-6186293a708a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 385149 ms
Total Talk Time (AGENT): 140430 ms
Total Talk Time (CUSTOMER): 139632 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/8fb84c11-def3-460b-85ea-6186293a708a_20250515T19:12_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, hi [PII], this is [PII]. Um, I'm calling from provider's office to check on claim status.
[AGENT][NEUTRAL] OK, I can check on a claim for you. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] The call back number is.
[CUSTOMER][NEUTRAL] [PII]. Extension will be [PII].
[AGENT][NEUTRAL] Thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, I do have a policy ID with me, the policy ID number with.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It starts at 01666110 ML Lima 8.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] The name is [PII] O. Date of birth is [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that and what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Medical services, the pathology services has been built on the claim.
[AGENT][NEUTRAL] I'm sorry the date of service for this claim, please.
[CUSTOMER][NEUTRAL] Oh, the your service is.
[CUSTOMER][NEUTRAL] 1024 24.
[CUSTOMER][NEUTRAL] We'll charge $319 even.
[AGENT][NEUTRAL] OK, that was 1024 24 for $319.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] So we did receive this claim [PII] we were unable to pay a benefit.
[AGENT][NEUTRAL] As the max benefit payable for this state of service had been met.
[CUSTOMER][NEUTRAL] So the primary insurance was busy with and they applied to a deductible. So the second is, second is your APL, uh, APL is stating that claim is received, um.
[AGENT][NEUTRAL] The claim was received.
[AGENT][NEGATIVE] We were unable to pay a benefit as their outpatient benefit with us. It pays on a per calendar day basis. It pays up to $500 per calendar day and that had been met prior to this claim.
[AGENT][NEUTRAL] For the state of service.
[CUSTOMER][NEUTRAL] So the
[CUSTOMER][NEUTRAL] So out of uh the out of pocket benefit has been raised, but you mean to say that?
[AGENT][NEUTRAL] The benefit that they have with us payable had been met so there's nothing additional that we could pay if you'd like I can send you a copy of this EOB.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, will you please help me with the
[CUSTOMER][NEUTRAL] Well claim number before sending that.
[AGENT][NEUTRAL] Yes, the claim number is 3601048.
[CUSTOMER][NEUTRAL] 360-1048
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] What will be the received date and the denied date of the claim?
[AGENT][NEUTRAL] This claim was received [PII].
[AGENT][NEUTRAL] And it was processed [PII]. 0, that's OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] But it was received [PII] and it was processed on [PII].
[CUSTOMER][NEUTRAL] So the denied reason, will you please, uh, say it one more time so I can note it that.
[AGENT][NEUTRAL] The maximum amount payable for this state of service has been met.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] So the maximum amount payable has been met for the services and it was
[AGENT][NEUTRAL] For this date of service.
[CUSTOMER][NEUTRAL] All those.
[CUSTOMER][NEUTRAL] They per calendar do they allowed $500 am I right? $500 which has been met.
[AGENT][NEUTRAL] Per calendar day, yes, so they're allowed $500 per calendar day and that had been met prior to us receiving this claim.
[CUSTOMER][NEUTRAL] They has been met. So that has been met under the same provider or different provider?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] That is a it was a different provider.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Sure. Uh, will you please help me with the EOB and fax me the EOB on my fax?
[AGENT][NEUTRAL] Yes, what was that fax number?
[CUSTOMER][NEUTRAL] So the fax number I do.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Just um.
[CUSTOMER][NEUTRAL] So the fax number is [PII]. Attention to [PII].
[AGENT][NEUTRAL] OK, I'm gonna read that back to you to make sure I heard that correctly. That was [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and that was attention [PII]?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, I'll go ahead and get that sent now. I should get it within about 10 minutes or so. And was there anything else I could help you with?
[CUSTOMER][NEUTRAL] Uh yeah, please help me with the call reference number for this call.
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. So my name is spelled [PII]
[CUSTOMER][NEUTRAL] Will you please spell for me?
[CUSTOMER][POSITIVE] Thank you very much, [PII].
[AGENT][POSITIVE] Of course thanks for calling APL you too thank you bye bye.
[CUSTOMER][POSITIVE] Have a wonderful day ahead. Bye.
[CUSTOMER][NEUTRAL] But