AccountId: 011433970860
ContactId: 92662cff-3e30-4ff2-8692-5cf8a597e4e9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 291730 ms
Total Talk Time (AGENT): 82985 ms
Total Talk Time (CUSTOMER): 137152 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/92662cff-3e30-4ff2-8692-5cf8a597e4e9_20250314T18:53_UTC.wav
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[AGENT][POSITIVE] Good afternoon, thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office seeking a claim status.
[AGENT][NEUTRAL] OK, I verify claim status for you and I apologize, your name is again?
[CUSTOMER][NEUTRAL] OK. My name is [PII] and my first initial and last name is [PII].
[AGENT][NEUTRAL] I'm sorry, you said [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] Yeah, and the policy number is 1067611.
[AGENT][POSITIVE] OK, thank you so much. Give me one moment.
[AGENT][NEUTRAL] Let's see. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, it's [PII] with an extension of [PII].
[AGENT][NEUTRAL] OK, thank you. And [PII], verify the patient's name, date of birth?
[CUSTOMER][NEUTRAL] OK, patient's first name is.
[CUSTOMER][NEUTRAL] [PII] and last name is [PII] and date of birth would be [PII].
[AGENT][NEUTRAL] OK, thank you. And what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] Date of service is [PII].
[CUSTOMER][NEUTRAL] And the total bill amount is $3,045 even.
[AGENT][NEUTRAL] And the balance after primary?
[CUSTOMER][NEUTRAL] OK, just a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 441.
[AGENT][NEUTRAL] 44
[AGENT][POSITIVE] OK, thank you. Give me one moment, please.
[AGENT][NEUTRAL] OK, and while I'm looking up claim information, just to let you know we do have an online service center where providers can check claim status as well as print out the EOB. That site is at [PII].
[AGENT][NEUTRAL] And uh the name of the provider's office?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK OK.
[CUSTOMER][NEUTRAL] Gal anesthesia Associates.
[AGENT][NEUTRAL] OK, um, well, I show the claim process is the outpatient benefit has max for that occurrence.
[CUSTOMER][NEUTRAL] Uh, I didn't catch you really. Could you please, uh, explain or, uh, could you please say it in a brief?
[CUSTOMER][NEUTRAL] Debrief me more about it. Uh, is it a denial?
[AGENT][NEUTRAL] Yes, the claim was processed as the outpatient benefit has maxed for that occurrence.
[CUSTOMER][NEGATIVE] Outpatient benefits has been exhausted.
[AGENT][POSITIVE] For that occurrence, correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, outpatient benefits have been exhausted. All right. And could you please provide me the claim received and processed dates if you don't mind.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, claim received [PII], processed on [PII].
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] Number [PII], right.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh no, you said the payment was processed on [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and what was the, the statement yesterday? Outpatient benefits has been maxed for current.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. And what do you suggest us to do you suggest us to build patient?
[CUSTOMER][NEUTRAL] For this claim?
[AGENT][NEUTRAL] We can't give patient responsibility. We can only verify how the claim was processed.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But I can say this is all we have.
[CUSTOMER][NEUTRAL] Fid and anesthesia.
[CUSTOMER][NEUTRAL] OK, just, just, just give me a quick moment. Let me pull up some information. Uh, can I place your call on mute for a moment? I'll put, I would like to work in silence for a moment. I need to take up some information, pull up some information. Is it OK for you?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Sure, that's fine. That's fine.
[CUSTOMER][POSITIVE] Uh, OK, alright, thank you so much. Just a moment. I'll be back soon.
[AGENT][NEUTRAL] Mhm.