AccountId: 011433970860
ContactId: a28808a0-df73-425f-8fc8-4916eec0d4ec
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 259170 ms
Total Talk Time (AGENT): 104128 ms
Total Talk Time (CUSTOMER): 78712 ms
Interruptions: 1
Overall Sentiment: AGENT=1.7, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/a28808a0-df73-425f-8fc8-4916eec0d4ec_20250502T16:48_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from the broadest office of Prisma Health University Medical Group and uh
[CUSTOMER][NEGATIVE] And this is a follow-up call, and I just left the uh denied reason. Could you assist me with it?
[AGENT][NEUTRAL] OK, CJ, you're needing claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] Thank you. And that's for [PII] with extension of [PII].
[AGENT][NEUTRAL] OK, thank you. And the member's policy number that you're calling on?
[CUSTOMER][NEUTRAL] Uh, that's uh number 024.
[CUSTOMER][NEUTRAL] 654-667.
[CUSTOMER][NEUTRAL] The patient's name is uh [PII].
[AGENT][NEUTRAL] OK, just one moment. OK, give me a moment please to get the member's information pulled up CJ because I can't see any of that yesterday. I mean, yeah, one moment.
[CUSTOMER][POSITIVE] Yeah, yeah, course. Take your time.
[AGENT][NEUTRAL] And any information provided, CJ will be a verification of benefits and not a guarantee of payment. What is the patient's name again and date of birth?
[CUSTOMER][NEUTRAL] And that's [PII], and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][POSITIVE] Yeah, you're welcome.
[CUSTOMER][NEUTRAL] And uh that's for 116 of 2024. $1,968 even.
[AGENT][NEUTRAL] I'm so sorry. 1, give me, OK, give me the billed amount again. 1000.
[CUSTOMER][NEUTRAL] And especially, I do have a
[CUSTOMER][NEUTRAL] 968, which is 1968.
[AGENT][NEUTRAL] OK, one moment please.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, and do you already have this claim number CJ?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Uh, yes, so [PII].
[AGENT][NEUTRAL] OK, what claim number do you have so that I can verify you have the correct number?
[CUSTOMER][NEUTRAL] OK. And that's uh 358-090-2.
[AGENT][POSITIVE] OK. Yes, sir. And how can I help you with that?
[CUSTOMER][NEUTRAL] OK. Uh, can I know the, uh, the reason?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Just one moment.
[AGENT][NEUTRAL] The denial remark on this claim states outpatient benefit.
[AGENT][NEUTRAL] For this calendar year has been met.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And it was met with another claim that was processed for the same date of service prior to this claim being received.
[CUSTOMER][NEUTRAL] OK, that's uh outpatient benefit.
[AGENT][NEUTRAL] And if you need
[AGENT][NEUTRAL] Mhm. Outpatient benefit for this calendar year has been met.
[CUSTOMER][NEUTRAL] Yes, go ahead.
[AGENT][NEUTRAL] And if you need a copy of that explanation of benefits, you can print that because you have the claim number you can print that from our portal by going to [PII].
[CUSTOMER][POSITIVE] Uh thank you, uh, [PII].
[AGENT][POSITIVE] You're welcome. And is there anything else I could help you with today, [PII]?
[CUSTOMER][POSITIVE] Uh, no, uh, [PII], thank you. Thank you for asking me today.
[AGENT][POSITIVE] Well, you're very welcome and thank you for calling APL. I hope you have a nice day and a nice weekend.
[CUSTOMER][POSITIVE] Yup. Thank you, [PII]. Take care and bye-bye.
[AGENT][POSITIVE] Uh-huh. You're welcome. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.