AccountId: 011433970860
ContactId: ad09e966-6f68-449b-b49f-b54b9e211f9d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 808640 ms
Total Talk Time (AGENT): 132521 ms
Total Talk Time (CUSTOMER): 157550 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=-1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/ad09e966-6f68-449b-b49f-b54b9e211f9d_20250317T17:53_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the provider office to check on the claim status.
[AGENT][NEUTRAL] OK, Ms. [PII], I can help you with the claim status. Can I please get your callback number and the name of the provider's office you're calling from?
[CUSTOMER][NEUTRAL] Sure, callback number is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you and what is the name of the patient, their date of birth and policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So the member's policy number is 02505608 and the patient's name is [PII]. And the last name is [PII], and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you. Let me pull that policy up for us real quick.
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEUTRAL] Sure, go ahead.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And um what is the data service for [PII] and the charge amount?
[CUSTOMER][NEUTRAL] Date of service is [PII] for the total charge amount of $4,389.14 which is 4389.14.
[AGENT][NEUTRAL] Thank you and then what is the um name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Medical City, [PII].
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up this claim and I'll be right back.
[CUSTOMER][NEUTRAL] Sure, go ahead.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Thank you for holding for me, [PII]. I have the claim. The claim number is.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] 3554874.
[CUSTOMER][NEUTRAL] Yeah, one moment, please.
[CUSTOMER][NEUTRAL] Could you please repeat it once again?
[AGENT][NEUTRAL] 554874.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim was denied because the benefit had been maxed for that date of service.
[CUSTOMER][NEGATIVE] So the maximum benefits exhausted.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] May I know as per this dollars or?
[CUSTOMER][NEUTRAL] Visits
[AGENT][NEUTRAL] It is dollars.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] May I know how much has been allowed and how much has been met?
[AGENT][NEUTRAL] It's only allowed $50.
[CUSTOMER][NEUTRAL] So, how much has been met? Totally it has been met.
[AGENT][NEUTRAL] $50.
[AGENT][NEGATIVE] Yes, it's exhausted.
[CUSTOMER][NEUTRAL] OK. May I know when it has been met?
[AGENT][NEUTRAL] It was me
[AGENT][NEUTRAL] On the same day by a different provider.
[CUSTOMER][NEUTRAL] Uh, so, it is [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Defined by different provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] One moment, please.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] May I know how much dollar amount has patient made excluding this claim?
[AGENT][NEUTRAL] If the claim only pays $50 because it's an indemnity plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Has the patient met the allowed dollar amount excluding this claim?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Service
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][POSITIVE] Yes, the answer is yes, they met it.
[AGENT][NEUTRAL] And then it is exhausted. That's why the claim was denied because the benefit amount for that date of service had been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Could you please provide me the call reference number for this call and provide me the EOB of this one?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Ma'am, you can use my name and today's date and if you give me your fax number, I'll send the EOB to you.
[CUSTOMER][NEUTRAL] Sure. The fax number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I get that fax ready for you and I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Come on.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, [PII]. I've got that fax on its way to you now.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. May I know when will I receive it?
[AGENT][NEUTRAL] I just gotta give it time to get there. It's been sent.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And may I know the claim received and denied date?
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Let me look.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We received the claim on [PII] and processed it.
[AGENT][NEUTRAL] On the same day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you please spell out your name for me?
[AGENT][NEUTRAL] Yes, ma'am. It's [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you, thank you, [PII]. Thank you for your assistance. Have a great day.
[AGENT][POSITIVE] You too, Ms [PII] you have a good day. I've helped you with everything I can today. Do you need any more help?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Uh, that's all for today. Thank you, sir. Thank you for your assistance. Have a great day.
[AGENT][POSITIVE] You have a good day too and thanks for calling APL bye bye.