AccountId: 011433970860
ContactId: 9c1021b0-512b-4fa0-89c4-a588505d2451
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1093930 ms
Total Talk Time (AGENT): 227450 ms
Total Talk Time (CUSTOMER): 263653 ms
Interruptions: 4
Overall Sentiment: AGENT=0.7, CUSTOMER=-1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/9c1021b0-512b-4fa0-89c4-a588505d2451_20250327T20:19_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling on behalf of provider office.
[AGENT][NEUTRAL] OK, how may I assist you today, Miss [PII]?
[CUSTOMER][NEUTRAL] I'm checking for the claim status.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And may I have the name of the facility you're calling from, Ms. [PII]?
[CUSTOMER][NEUTRAL] Uh, the name of the facility is.
[CUSTOMER][NEUTRAL] Um it's it's Rockfordalician.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you have the patient's policy number?
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Yes, the policy number is 022146778.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] The patient's name is [PII].
[CUSTOMER][NEUTRAL] Uh, date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] I'm sorry, can you repeat that?
[CUSTOMER][NEUTRAL] And the bill amount is $35.65.
[AGENT][NEUTRAL] Can you repeat the date of service?
[CUSTOMER][NEGATIVE] beat him up.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said it was $35 and how many cents?
[CUSTOMER][NEUTRAL] 65 cents.
[AGENT][NEUTRAL] 55 cents. OK. Let me see if I can find this claim for you. I'm gonna put you on a brief hold so I can make the search, OK?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, for this patient, I have another date of service. Can I provide that one? OK.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] It's [PII]. The bill amount is $541.23.
[AGENT][NEUTRAL] You said [PII] of $22 for $541.23?
[CUSTOMER][POSITIVE] So that's right.
[CUSTOMER][NEUTRAL] 43 cents.
[AGENT][NEUTRAL] OK. OK, one moment. Let me go ahead and search for these claims, OK?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] May I know your name, please?
[AGENT][NEUTRAL] My name is [PII]. That's [PII] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] OK, one moment. You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] OK, Ms. [PII]. Yeah, yes, I can hear you now. Um, I did find both of the claims. So the first one, which is [PII], um was processed and um denied stating that um the outpatient benefits for the calendar year has been met. And this one was processed on let's see.
[CUSTOMER][NEUTRAL] Can you hear me?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] It's applied for the patient deductible.
[AGENT][NEGATIVE] No, outpatient maximum for the date of service has been met. That is the denial reason on this one.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You see the uh patient deductible, uh, the patient limit has been reached, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, may I know the claim was, could you please send a copy of your with that?
[AGENT][NEUTRAL] OK, what is the fax number?
[CUSTOMER][NEUTRAL] To fax.
[CUSTOMER][NEUTRAL] Uh, before moving to, uh, the claim was received it, when the claim received it.
[AGENT][NEUTRAL] One moment, let me go back.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] There
[AGENT][NEUTRAL] OK, bear with me because that information is not on the EOB.
[AGENT][NEUTRAL] OK, it was received on [PII], processed [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, the paid amount is 0.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And it's denied, right?
[AGENT][NEUTRAL] Denied because the member has to so that the benefit.
[CUSTOMER][NEUTRAL] OK, the claim
[CUSTOMER][NEUTRAL] Uh, the member has been crossed the maximum number of benefits has been expressed, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, may I know the maximum number, may I know the benefits, number of benefits.
[AGENT][NEUTRAL] OK let me get that for you.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, this is an old policy, so I had to search and see how much it was at that time.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, let's see, outpatient calendar year 4700 was the calendar year maximum.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] 1700, right?
[AGENT][NEUTRAL] 4700.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, how many has been met?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] The whole amount was meant.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, the dog.
[CUSTOMER][NEUTRAL] For the dollar value, maximum number of benefits is for the uh for, for the dollar value of $4700 and OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]. Correct. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm, OK, OK, could you, can I give you the, uh, can I know the claim number?
[AGENT][NEUTRAL] Yes, the claim number on this one is.
[AGENT][NEUTRAL] I had it written differently, OK, so that is um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That's 3.
[CUSTOMER][NEGATIVE] No plans.
[AGENT][NEUTRAL] 220,020.
[CUSTOMER][NEUTRAL] 322-020, right?
[AGENT][NEUTRAL] 322-002-0.
[CUSTOMER][NEUTRAL] It's 322-002-0 right?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK. May I know the next claim status?
[AGENT][NEUTRAL] Yes, give me just a minute.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] All right. The next date of service, which is [PII], um, this one was denied stating that office visits are not covered by the policy. And let me see the date of the process, one moment.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Hmm.
[AGENT][NEUTRAL] OK, so this one was received on [PII], processed [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII] and processed on [PII], right?
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] OK, the claim was denied for non-covered services for the office visit?
[AGENT][NEUTRAL] Yes, office visits are not covered.
[CUSTOMER][NEUTRAL] OK. For the patient plan or the provider plan?
[AGENT][NEUTRAL] Patients plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, may I know the claim number?
[AGENT][NEUTRAL] Yes, the claim number is 3249312.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] OK, because as my office is under the patient one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you please send, uh, could you please send the both UB?
[AGENT][NEUTRAL] What is the fax number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, right.
[AGENT][NEUTRAL] OK, I will have to send this before I let you go. So do you mind holding for me while I send them out?
[CUSTOMER][NEUTRAL] On
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] You're holding and being patient for Ms. [PII]. Yeah, I went ahead and send that over to you. Should be there in a few minutes. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] OK. May I know the call reference?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name and today state.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Thank you for your patience.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] It's SOL, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and today's date [PII]. OK. Thank you for your patience. Bye-bye.
[AGENT][POSITIVE] You're welcome. Have a good day.