AccountId: 011433970860
ContactId: 9a31633d-0eaa-4831-a91c-77e13ddd9a0f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 294380 ms
Total Talk Time (AGENT): 84143 ms
Total Talk Time (CUSTOMER): 109653 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/9a31633d-0eaa-4831-a91c-77e13ddd9a0f_20250516T20:19_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, sir. I'm [PII]. I'm calling from provider's office regarding our claims.
[AGENT][POSITIVE] All right, [PII], I'm happy to check a claim. What's the policy number?
[CUSTOMER][NEUTRAL] The policy number is going to be 01820389.
[CUSTOMER][NEUTRAL] M as in Mike, L as in Lima, number 8.
[AGENT][POSITIVE] Alright, thank you. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's first name is going to be, it's
[CUSTOMER][NEUTRAL] It, it's [PII], I'm sorry. Yeah, it's [PII] Am I right?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah, and the last name is [PII] Ms [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] And what's the date of service?
[CUSTOMER][NEUTRAL] The date of service is going to be, it's [PII] with a bill amount of $4,288 even.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEGATIVE] We did get a claim for this state of service. Uh, looks like it was denied. The max.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] Benefit for the data service had had already been paid.
[CUSTOMER][POSITIVE] Yeah. Yeah, I'm sorry.
[CUSTOMER][NEUTRAL] OK, you are stating that maximum benefits has been already existed, right, for this claim. Mhm.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Got it. In this case, may I know when the claim has been received and processed and, I mean, denied? Could you please tell me the dates?
[AGENT][NEUTRAL] Claim is received on [PII]. Claim is processed and denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. I just wanted to make sure you have been stated that the claim, uh, the claim was denied, uh, for maximum benefits exhausted. I just wanted to know, is it denied for as per dollar amount or as per the visits and as for the units? It was maximum benefits exhaustion.
[AGENT][NEUTRAL] It was the dollar amount.
[CUSTOMER][NEUTRAL] You know, what is the maximum dollar amount?
[AGENT][NEUTRAL] Maximum outpatient benefit per calendar day is $500.
[CUSTOMER][NEUTRAL] $500 you want right?
[AGENT][NEUTRAL] Per calendar day, yes.
[CUSTOMER][NEUTRAL] Per calendar date.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Got it. In this case, can you send me the copy of your denied YB through fax.
[AGENT][NEUTRAL] That's
[AGENT][NEUTRAL] What's a good fax number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, should we mark attention to anybody?
[CUSTOMER][NEUTRAL] In addition to my name [PII]
[AGENT][NEUTRAL] OK, that's on its way. Is there anything else I can help with today, [PII]?
[CUSTOMER][NEUTRAL] Could you please help me uh deny the claim number and as well as call reference.
[AGENT][NEUTRAL] Claim number is 3570079.
[CUSTOMER][NEUTRAL] 350, it's 3570079. Am I right?
[AGENT][NEUTRAL] And the
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it. Go on.
[AGENT][NEUTRAL] Call reference is my name with my last initial in today's date. My name is [PII], that is spelled [PII]
[AGENT][NEUTRAL] Initial to my last name is [PII], then today's date.
[CUSTOMER][POSITIVE] Thank you, sir. Uh. That's all the information I need. Thank you for the information. Thank you. That's it. Mhm.
[AGENT][NEUTRAL] You're welcome. Have a
[AGENT][POSITIVE] Have, have a good day.