AccountId: 011433970860
ContactId: 97274863-6d6e-4006-b1d4-d5d4d0fe2046
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 244759 ms
Total Talk Time (AGENT): 87329 ms
Total Talk Time (CUSTOMER): 80354 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/97274863-6d6e-4006-b1d4-d5d4d0fe2046_20250307T19:30_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], good afternoon. My name is [PII]. Last name initial is [PII], and I am calling from Lab car billing. This line will be recorded for training and quality purposes. I am calling about the claim status we submitted to you.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the claim status and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh, sure, our callback number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Sure, it's 018.
[CUSTOMER][NEUTRAL] 978
[CUSTOMER][NEUTRAL] 71.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh, your patient name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [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 and the total bills for the claim?
[CUSTOMER][NEUTRAL] Data service of [PII] with the bill amount of $254.10.
[AGENT][NEUTRAL] So that was [PII] and the amount of $264.10.
[CUSTOMER][NEUTRAL] It's 5454.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] It's Labor, Dublin.
[AGENT][NEUTRAL] So I'm trying to received the claim on [PII].
[AGENT][NEUTRAL] The claim number
[AGENT][NEUTRAL] It's 354-3102.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII]
[CUSTOMER][NEUTRAL] And also
[CUSTOMER][POSITIVE] Go on, I'm so sorry.
[AGENT][NEUTRAL] On [PII], the claim was denied. Hold on one moment, let me get the denial reason for you.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] The outpatient benefit for the calendar year has been met.
[CUSTOMER][NEUTRAL] Oh alright, I'll just take note of that, ma'am. And can you please let us know, ma'am, what needs to be submitted to have this claim processed?
[AGENT][NEUTRAL] Um, nothing needs to be submitted. The max for the year was $3500 and by the time your claim came in, that max had been used, so there's nothing else to pay. They've used all their benefits, we can't pay out.
[CUSTOMER][NEUTRAL] Alright, thank you, ma'am. And do you have a specific mailing address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Alright, thank you so much for that, ma'am and uh and also that just for the documentation purposes, can I please have the initial of your last name?
[AGENT][NEUTRAL] Sure, it's [PII].
[CUSTOMER][NEUTRAL] And do you have the reference number for the call?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date.
[CUSTOMER][POSITIVE] All right, thank you so much for that, ma'am [PII] and for assisting me today. You have a great day.
[AGENT][POSITIVE] You're welcome. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] And then so far that's all thank you.
[AGENT][POSITIVE] Alright, thanks for calling APL. Bye bye.