AccountId: 011433970860
ContactId: 9c63d2b0-6755-4820-8ae1-8ff7a11e10d7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 769880 ms
Total Talk Time (AGENT): 150838 ms
Total Talk Time (CUSTOMER): 256794 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/9c63d2b0-6755-4820-8ae1-8ff7a11e10d7_20250602T15:24_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Can you spell your name please?
[AGENT][NEUTRAL] Yes, it's [PII]
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] So your voice is breaking, can you repeat it?
[AGENT][NEUTRAL] Yes, it's [PII]
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Your last name, please?
[AGENT][NEUTRAL] A
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from Pro office to check on claim status. Could you please help me with this?
[AGENT][NEUTRAL] Yes, [PII], I can help you with claim status. May I please get your callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] Thank you. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] [PII] [PII] and the policy ID is 02332588 ML 7.
[AGENT][NEUTRAL] OK, let me look that up.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] All right. And may I please have the date of service and the charge amount?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It, it's on [PII] and $1,504 even.
[AGENT][NEUTRAL] OK, and then what are the charges after the primary paid their part?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] The charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And may I have the balance after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Actually, we got a dinner as PR 119 benefits maximum for this time period occurrence has been reached.
[AGENT][NEUTRAL] So you do have the claim status.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what is the claim number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It's 354-559-8.
[AGENT][NEUTRAL] OK, and may I get the name of the facility you're calling for?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Flamingo Nastasia Associates.
[AGENT][NEUTRAL] OK, Ms. [PII], I'm gonna put you on a quick hold while I search this claim and I'll be right back.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you Ms. [PII] for holding for me and you are correct, the claim has been denied because the benefit amount for the calendar year has been met.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Do.
[CUSTOMER][NEUTRAL] The healthcare.
[CUSTOMER][NEUTRAL] OK. How much he made, can I know?
[AGENT][NEUTRAL] Uh, they get $2000 per calendar year, and this is just to verify benefits. It's not a guarantee of payment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] We did not get any payments from this.
[AGENT][NEUTRAL] No, because the calendar year benefit for the year has been met.
[CUSTOMER][NEUTRAL] OK, what is the next step to be followed?
[AGENT][NEUTRAL] That depends on your provider on what they want to do.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] The patient has met as per visit wise or dollar ways.
[AGENT][POSITIVE] Yes, the benefit for the calendar year has been met.
[CUSTOMER][NEUTRAL] He's saying that.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Calendar year.
[CUSTOMER][NEUTRAL] OK. 2000 per calendar year.
[CUSTOMER][NEUTRAL] Just a review that 11.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sorry, I did not get, can you explain it briefly for me?
[CUSTOMER][NEUTRAL] The the 2000 calendar.
[AGENT][POSITIVE] The benefit for the calendar year has been met.
[CUSTOMER][NEUTRAL] Uh, as per like 2000 per calendar means.
[AGENT][POSITIVE] That's their benefit and it's been met. They've used it up.
[CUSTOMER][POSITIVE] Actually it will be like a visit to a dollar wise the patient will be met.
[AGENT][NEUTRAL] They have met their $2000 calendar year benefit for the year.
[CUSTOMER][NEUTRAL] $2000 per calendar year, right?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Is that everything I can help you with today?
[CUSTOMER][NEUTRAL] Just a moment, we are verifying with our just a moment, please. Uh, can I know the mid date please?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] No, that's private information. It's not your facility.
[CUSTOMER][NEUTRAL] Con contact call me.
[CUSTOMER][NEUTRAL] It is there for data of service. It is there for date of service within date of service.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEGATIVE] I'm not gonna give that information, that's private information.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Can I get the call reference number?
[AGENT][NEUTRAL] Yes, you can use my name [PII], in today's date.
[CUSTOMER][NEUTRAL] for
[CUSTOMER][NEUTRAL] OK. Could you help me with another?
[AGENT][NEUTRAL] Help you with
[CUSTOMER][NEUTRAL] A another invoice and claim another claim.
[AGENT][NEUTRAL] Yes, yes. What is the member's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] We can
[CUSTOMER][NEUTRAL] Just a moment pulling the details.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One night.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] It's [PII] and date of birth is on [PII].
[AGENT][NEUTRAL] Thank you. And the policy number?
[CUSTOMER][NEUTRAL] It's NCA F E 681597-739.
[AGENT][NEUTRAL] OK, that is not an APL policy number. Do you see another number?
[CUSTOMER][NEUTRAL] That is not
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, that is not an APL policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's one member name is
[CUSTOMER][NEUTRAL] [PII] and the date of birth is on [PII].
[CUSTOMER][NEUTRAL] And the member's ID is 796906317.
[AGENT][NEUTRAL] OK, that is not a APL policy. Do you see another number?
[CUSTOMER][NEUTRAL] That's not
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] That is not an APL policy.
[CUSTOMER][NEUTRAL] Can't you pull with that?
[CUSTOMER][NEUTRAL] You can't find any with this number right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you for your valuable information. Have a good day.
[AGENT][POSITIVE] You have a wonderful day too, Ms. [PII], and thank you so much for calling APL. Is that everything I can help you with?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Do you have more?
[CUSTOMER][NEGATIVE] No, no.
[AGENT][POSITIVE] Oh, OK. Well, you have a beautiful day and thank you for calling APL. You take care, Ms. [PII].
[CUSTOMER][POSITIVE] OK you too bye bye.
[AGENT][NEUTRAL] Bye bye.