AccountId: 011433970860
ContactId: 9bbc6224-3acc-4584-870b-21d6b586719a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 366010 ms
Total Talk Time (AGENT): 130589 ms
Total Talk Time (CUSTOMER): 222265 ms
Interruptions: 8
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/9bbc6224-3acc-4584-870b-21d6b586719a_20250522T18:49_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Can I help you? Yeah, hi, my name is [PII] calling for claim service.
[AGENT][NEUTRAL] OK, I can verify claim status for you, [PII]. And what is the policy number, please?
[CUSTOMER][NEUTRAL] I can verify the
[CUSTOMER][NEUTRAL] And what is the policy number, please?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The policy number is 02521722.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And do you have a callback number in case the call drops? [PII] it's a direct line.
[AGENT][NEUTRAL] Thank you. Give me a moment and verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Verify the patient's date of birth. Patient's name is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, thank you. And [PII], what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] And like what was the date of service and the charge? The date of service is [PII].
[CUSTOMER][NEUTRAL] And the total charges is
[CUSTOMER][NEUTRAL] $1180 even.
[AGENT][NEUTRAL] OK, and the balance after primary?
[CUSTOMER][NEUTRAL] The balance after primary.
[CUSTOMER][NEUTRAL] Uh, it's
[CUSTOMER][NEUTRAL] $60.35.
[CUSTOMER][NEUTRAL] the
[AGENT][NEUTRAL] OK, thank you. Give me one moment, please. And while I'm looking at claim information, let you know we do have an online service center where providers can check claim status as well as print out the EOB.
[CUSTOMER][NEUTRAL] Please and while I'm looking at claim information for you.
[CUSTOMER][NEUTRAL] Have an online service center where providers as well as pronounce the EOB. That site is at [PII].
[AGENT][NEUTRAL] That site is at [PII].
[AGENT][NEUTRAL] And what was the name of the provider's office?
[CUSTOMER][NEUTRAL] OK. And what's the name of the provider's office? Medical University Hospital, MUSC.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] I'm showing that claim process as the benefit max has met for the data service.
[CUSTOMER][NEUTRAL] I'm showing that claim process as the benefit not met for the data service. OK, may I know the claim received it?
[AGENT][NEUTRAL] Sure, give me one moment.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Uh, show the claim was received [PII], processed on [PII].
[CUSTOMER][NEUTRAL] I saw the claim was received [PII] processed on [PII]. What's the claim number?
[AGENT][NEUTRAL] 3581067.
[CUSTOMER][NEUTRAL] 3581067 OK. And I have one more claim number for the same date of service. Shall I provide you the claim number?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure. 358366-2.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Yeah, that's a claim processed as benefits max for the data service.
[CUSTOMER][NEUTRAL] Yeah, that's a claims process and benefits max for the data service. OK.
[CUSTOMER][NEUTRAL] May I know on what basis is maximum benefit as this in terms of values or dollars or units.
[AGENT][POSITIVE] For a dollar value.
[CUSTOMER][NEUTRAL] For a dollar value. So how much the dollar has to build and how much is estimate?
[AGENT][NEUTRAL] They have met the full amount. Um, for the patient's policy, they have an outpatient benefit that pays up to $200 per calendar day, and they've already met that $200 for that day.
[CUSTOMER][NEUTRAL] They met the full amount, uh, for the patient's policy, they have an outpatient benefit that pays up to $200 for a calendar day, and they've already met that $200 on that day.
[CUSTOMER][NEUTRAL] Uh, so you have one more.
[CUSTOMER][NEUTRAL] Claim for that service.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] I'm sorry. So that is a claim on file another claim on file which was paid for $200 more than $200.
[AGENT][NEUTRAL] Correct. There's a claim on file where the benefit has maxed for that date.
[CUSTOMER][NEUTRAL] the best for that day. Um, may I know which what's the claim number the claim got paid previously for this?
[AGENT][NEUTRAL] No sir, I cannot give you that information since it's on another provider.
[CUSTOMER][NEUTRAL] In
[CUSTOMER][NEUTRAL] No sir I cannot give you that information on another provider. OK, so may I know the claim received it in the process of the second one which I told to you ending with 3662?
[AGENT][NEUTRAL] Uh, received [PII] processed on [PII].
[CUSTOMER][NEUTRAL] Uh, receive [PII] process on [PII].
[CUSTOMER][NEUTRAL] Could you please send us the UOB copy to my fax number for the 1st 1, 1067 and 366 to both the UOB copy?
[AGENT][NEUTRAL] OK, what is the fax number?
[CUSTOMER][NEUTRAL] What is the fax number? The fax number is [PII].
[CUSTOMER][NEUTRAL] Please send with attention, [PII]
[AGENT][NEUTRAL] And you said the fax number is [PII]?
[CUSTOMER][NEUTRAL] You said the fax number is [PII]. Yes, correct.
[AGENT][NEUTRAL] OK, and is there anything else, [PII], I can assist you with today?
[CUSTOMER][NEUTRAL] OK, and is there anything else I can assist you with today? Uh, what's the download on time for the EB to be received?
[AGENT][NEUTRAL] Uh, hopefully in a few moments.
[CUSTOMER][NEUTRAL] Uh, hopefully be a moment. Uh, may I know the appeal mailing address and timely filing limit?
[AGENT][NEUTRAL] Uh, to submit an appeal, you have up to 180 days from the time the claim was processed, and you must submit a letter stating the reason for the appeal.
[CUSTOMER][NEUTRAL] Uh, submit an appeal, you have up to 180 days from the time the claim was processed and you must submit a letter stating the reason for the appeal.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know your mailing address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 3124-8950
[CUSTOMER][NEUTRAL] May I know the call reference number for our conversation?
[AGENT][NEUTRAL] Uh, if you like, you may use my name at today's date.
[CUSTOMER][POSITIVE] Uh, if you like, you may use my name is [PII]. Thank you so much and have a nice day.
[AGENT][POSITIVE] You're welcome. Thank you for calling APL. Bye.
[CUSTOMER][POSITIVE] You're welcome thanks for calling Retail. You too, bye.
[AGENT][NEUTRAL] Mhm.