AccountId: 011433970860
ContactId: b3eb7953-b6f1-4d55-a9c6-e827a013bb8d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 321630 ms
Total Talk Time (AGENT): 129438 ms
Total Talk Time (CUSTOMER): 124762 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/b3eb7953-b6f1-4d55-a9c6-e827a013bb8d_20250521T18:15_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider's office to check on claim status. Could you please help us?
[AGENT][POSITIVE] 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] OK, and you said your name is [PII] or [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the name of the facility you're calling from for my notes, Miss [PII]?
[CUSTOMER][NEUTRAL] Oh sorry, could you please repeat one more time?
[AGENT][NEUTRAL] Uh, yes, the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Uh yes.
[CUSTOMER][NEUTRAL] Lakerange Emergency physician LLC.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] Yeah. 02573986
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] patient. Yeah, first name, [PII]. Last name [PII]. Date of birth, [PII]. [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Your date of service?
[CUSTOMER][NEUTRAL] Uh, [PII] and the bill amount $1280 even.
[AGENT][NEUTRAL] OK. [PII] for 1280. OK, let me see if I can find this claim and for future, you can check claim status online through our website at [PII] and that's just optional.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And let's see. OK, let me pull the CLB.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Looks like we processed the claim [PII] and the claim was denied. Um, let me get the denial reason. One moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] 9
[CUSTOMER][NEUTRAL] 18019.
[CUSTOMER][NEUTRAL] 508
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] The the reason is benefit maximum for the date of service has been manned.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] $16.
[CUSTOMER][NEUTRAL] May I know uh when was the uh maximum benefits met?
[AGENT][POSITIVE] It is the same data service. This one has a daily benefit.
[CUSTOMER][NEUTRAL] I guess.
[AGENT][NEUTRAL] So it was met on the same date of service.
[AGENT][NEUTRAL] But we cannot release any other information on the payment because it's a different provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Upon checking in our side, we didn't do any other claim for the date of service. This is the one we claim bill. Uh, could you please send back the claim form.
[AGENT][NEUTRAL] It's gonna be from another provider.
[AGENT][NEUTRAL] Ms. [PII], we get claims from different providers, yeah, so, um, we got it from a different provider, we process and they exhausted the benefit.
[CUSTOMER][NEUTRAL] OK. Another.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, the, the claim from another provider was built on the same date of service, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] That's right. OK.
[CUSTOMER][NEUTRAL] Um, can you submit a reciation for this one?
[AGENT][NEUTRAL] Can I submit what I'm sorry?
[CUSTOMER][POSITIVE] Good afternoon.
[CUSTOMER][NEUTRAL] Uh, reconsideration.
[AGENT][NEUTRAL] You will have to submit an appeal if you would like to. You have 180 days from the decision date to submit an appeal.
[CUSTOMER][NEUTRAL] OK, may I know the appeal mailing address?
[AGENT][NEUTRAL] Sure. The address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, could you please spell out your name for documentation purpose?
[AGENT][NEUTRAL] Sure, that's [PII]. Last initial is [PII]. Is there anything else I'm gonna help you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] Uh, may I know the claim decision date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, can I get a call reference number?
[AGENT][NEUTRAL] We don't have a reference numbers, you can use my name in today's date if you will.
[CUSTOMER][POSITIVE] OK. Thank you so much, sir. Thank you for assisting. Have a great day. Bye-bye.
[AGENT][POSITIVE] You're welcome. Thank you for calling APR. Have a good afternoon. Bye-bye.
[CUSTOMER][NEUTRAL] Oh.