AccountId: 011433970860
ContactId: 9457d65b-2c40-4bce-be97-aa47263db304
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 249039 ms
Total Talk Time (AGENT): 104519 ms
Total Talk Time (CUSTOMER): 59967 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/9457d65b-2c40-4bce-be97-aa47263db304_20250121T17:16_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider office. Need to check claim status.
[AGENT][POSITIVE] OK, I'd love to help you with claim status today, [PII]. And can I get a good callback number from you real quick?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] Thank you. And what's the policy number we're looking at today?
[CUSTOMER][NEUTRAL] It's 01603014 uh Mary uh Lima number 8.
[AGENT][POSITIVE] Thank you and let me see.
[AGENT][NEUTRAL] All right. Would you be able to verify for me, pretty please, your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And what is the date of service on the claim we want to look at?
[CUSTOMER][NEUTRAL] It's for [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] $450 even.
[AGENT][NEUTRAL] You said $450 or just $50? I'm sorry.
[CUSTOMER][NEUTRAL] $450.
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] And try, let's take a look.
[AGENT][NEUTRAL] And the name of the facility on file for the.
[AGENT][NEUTRAL] I'm sorry, the name of the facility on file?
[CUSTOMER][NEUTRAL] Facility name is Care Diagnostic for Women.
[CUSTOMER][NEUTRAL] LLC
[AGENT][NEUTRAL] OK
[AGENT][POSITIVE] Thank you, and I believe I found that claim for you, my friend, um.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] I show that we received your claim on 9-23-2024. It looks like we processed the claim on 9-25-2024.
[AGENT][NEUTRAL] And it looks like your claim number is 3509365.
[AGENT][NEUTRAL] I do show that claim was denied. I have the reason stating that outpatient benefits for this calendar year has been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can you just let me know how much limit is for outpatient services for this patient?
[AGENT][NEUTRAL] Yeah, absolutely, um, I do wanna let you know, obviously any benefit information I give over the phone is always a verification of coverage and never guarantee a payment, um, but our outpatient benefits for your patient was.
[AGENT][NEUTRAL] $1250 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And how much has been met?
[AGENT][NEUTRAL] Uh, that they met the calendar year benefit of 1250.
[CUSTOMER][NEUTRAL] OK. And can you just let me know the plan name for this number?
[AGENT][NEUTRAL] Yeah, the plan name is Min, M E D L I N K.
[CUSTOMER][NEUTRAL] Medlink, OK.
[CUSTOMER][POSITIVE] Thank you so much for that. And can you just provide me the reference number for this call?
[AGENT][NEUTRAL] Yeah, the reference number is my name, [PII], first initial, last name, [PII], and today's date?
[CUSTOMER][POSITIVE] Thank you so much, [PII], for your assistance. Have a great day. Stay safe. Bye-bye.
[AGENT][POSITIVE] My pleasure. Thank you, [PII]. You take care. Bye-bye.