AccountId: 011433970860
ContactId: 9df88674-bf79-41a6-9032-426ecfcb9218
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 647109 ms
Total Talk Time (AGENT): 173775 ms
Total Talk Time (CUSTOMER): 186292 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/9df88674-bf79-41a6-9032-426ecfcb9218_20250428T17:32_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] Hello, Ms. [PII]. This is [PII]. How are you, dear?
[AGENT][POSITIVE] Hey [PII], I'm good. How are you doing?
[CUSTOMER][POSITIVE] Good. I'm good, thank you. All this shouldn't be chaos.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] This is just a provider. Well, you know, verification. Let me give you the number. It is [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Somebody must have been updating her name the minute they call she called because it showed pulled in a different last name at first and I changed screens the uh the other name came so I was like, wow. OK.
[AGENT][NEUTRAL] OK, and the [PII], that's their number?
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Uh, you caught me off guard, honey. I'm sorry, I was over here switching screens. [PII]. Yes. And um did I give you the policy number yet?
[AGENT][NEUTRAL] Hold on one second.
[AGENT][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, you're fine, dear.
[CUSTOMER][POSITIVE] You are perfectly fine.
[CUSTOMER][NEGATIVE] I know y'all hang up and get another call not fish with your notes probably.
[CUSTOMER][NEUTRAL] That'll happen to us over here, especially before we got care team.
[AGENT][NEUTRAL] Oh my goodness, this is, sorry, [PII]. OK, I'm gonna let that go. Anyway, what, what is your patient name? I'm sorry, they're talking in the chat.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Oh, OK. It is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] [PII] is what she says her name is, but I thought she said [PII], when she spelled it, it's [PII]. She's calling on uh claim status that the service is 1210 $24 and the amount is $37.
[AGENT][NEUTRAL] And what do they mean?
[AGENT][NEUTRAL] You said 900 and how much?
[CUSTOMER][NEUTRAL] What, what's 900.
[AGENT][NEUTRAL] No, I didn't hear what you said. The
[CUSTOMER][NEUTRAL] No, that is
[CUSTOMER][NEUTRAL] Oh, data service is [PII], 24. The amount is $37.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 37. OK, so they just need claim status?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, you ready?
[AGENT][POSITIVE] Yeah, I'm ready.
[CUSTOMER][POSITIVE] All right. Thank you, dear. Have a good day, Ms. [PII].
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hi, um, this is [PII] with APL and you were calling for claim status?
[CUSTOMER][NEUTRAL] Yeah, hi, [PII], this is [PII] calling from the provider's office to check on a claim status, yes.
[AGENT][NEUTRAL] OK. And [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Oh, sure. It's [PII].
[AGENT][POSITIVE] Thank you, and um she gave me the date of service [PII] for $37.
[CUSTOMER][POSITIVE] Yes, ma'am. Perfect.
[AGENT][NEUTRAL] All right, and all the information provided is a verification of benefits, not a guarantee of payment. And hold on one moment while I locate that claim, OK?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Catering Network radiologist.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] And [PII], do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] Sure, sure.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, now let me do my call. I gave her the right information. Let's go.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Uh, yes, tell me.
[AGENT][POSITIVE] Thank you so much for holding. I do apologize for that wait. So I'm showing the claim was received originally on February. Well, are you calling for the original claim or the resubmitted claim?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] With.
[CUSTOMER][NEUTRAL] 7.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, the original claim.
[AGENT][NEUTRAL] OK, it was received on [PII].
[AGENT][NEUTRAL] That claim number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's 356-9480.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because the outpatient benefit for the calendar year has been met.
[CUSTOMER][NEUTRAL] Outpatient benefit for the canary year has met, right?
[AGENT][NEUTRAL] Yes. So this policy has a um outpatient max of $2,025 per calendar year and by the time this claim came in, it had been used.
[CUSTOMER][NEUTRAL] OK, it has met the 2500, so it was denied, right?
[AGENT][NEUTRAL] Correct, it was denied because the outpatient max has been used.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, I understand. Uh, may I know what's the recent claim status? It was denied for the same reason?
[AGENT][NEGATIVE] It was denied as a duplicate because the original advised that the max was used.
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] OK, I understand.
[CUSTOMER][NEUTRAL] OK, so what would you suggest to process this claim, ma'am? What would you suggest me to do?
[AGENT][NEUTRAL] There's nothing you can do. The max that is for this policy has been used, so there's no more benefits until next year.
[CUSTOMER][NEUTRAL] So we can build the patient for this, right?
[AGENT][NEUTRAL] Uh, we don't determine patient responsibility because we're not the major medical, so it will be whatever your company's policies are on remaining outstanding balances.
[CUSTOMER][NEUTRAL] OK. Can you able to fax me the copy of your ma'am?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] Uh yeah, it's [PII].
[AGENT][NEUTRAL] For the fax number, there's an extension?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, that's what you just gave me. Can you repeat the fax number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and does that need to be attention [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and that was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Alright, so I'm gonna go ahead and send this over for you now. Is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] No, can I get your call reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date, and again, my name is [PII].
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][POSITIVE] OK, thank you so much have a great day bye bye.
[AGENT][POSITIVE] You also, and thanks for calling APL. Bye-bye.