AccountId: 011433970860
ContactId: b6f7fe3d-04fe-4f06-9deb-163db25565a3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 493850 ms
Total Talk Time (AGENT): 108829 ms
Total Talk Time (CUSTOMER): 182458 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/b6f7fe3d-04fe-4f06-9deb-163db25565a3_20250228T20:19_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] My name is [PII]. I'm calling from provider office to check the claim status.
[AGENT][NEUTRAL] I can help you, [PII]. What's up?
[CUSTOMER][NEUTRAL] Could you please help me?
[AGENT][NEUTRAL] I can help you. What's the policy number?
[CUSTOMER][NEUTRAL] The policy number is 01663752 M as in L as in Lima 7.
[AGENT][NEUTRAL] And what's a good phone number [PII] in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is uh [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Elderly, sir.
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK and you said you're checking a claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And the date of service and charge?
[CUSTOMER][NEUTRAL] Rate of service [PII]. Charge amount $39,887 even.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Still looking.
[CUSTOMER][NEUTRAL] Before
[AGENT][NEUTRAL] OK, thank you for holding. I show that this claim was received, um, [PII].
[AGENT][NEUTRAL] The claim was processed [PII]. Um, the maximum outpatient benefit is exhausted, so there was no payment made on this claim for that reason.
[CUSTOMER][NEUTRAL] Sorry. Uh, could you please repeat the denial reason?
[AGENT][NEUTRAL] The maximum outpatient benefit is exhausted?
[AGENT][NEUTRAL] It's kind of loud in the background.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] I it.
[AGENT][NEUTRAL] Did you need the claim number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] That number is 355.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 7255.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Could you please wait for a little moment?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. May I know is that the dollar value or the number of visit?
[AGENT][NEUTRAL] It's the maximum dollar amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What was the amount?
[AGENT][NEUTRAL] The maximum is $750 per calendar year.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, could you please give me the reference number?
[AGENT][NEUTRAL] My name in today's date, [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the first initial of my last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Could you please give me the one more account?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Could you please give me the information for the one more account?
[AGENT][NEUTRAL] Give you the information for one more account.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, I have one more account, one more claim.
[AGENT][NEUTRAL] Another policy number. OK. What is that number?
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, the policy number is
[CUSTOMER][NEUTRAL] 022
[CUSTOMER][NEUTRAL] 840
[CUSTOMER][NEUTRAL] Are you there?
[AGENT][NEUTRAL] I'm, uh, 022840.
[CUSTOMER][NEUTRAL] 54 M as in Mary, L as in Lima, and number 8.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And the date of service?
[CUSTOMER][NEUTRAL] Date of service.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yes, it's [PII]. So the charge amount is $6,322.25.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, as here, I found that we have, uh, sent the primary UB on [PII] to the mailing address. It's [PII], [PII], OK, [PII]. Is this the correct mailing that we can send the primary UV?
[AGENT][NEUTRAL] That's the correct mailing address. One moment.
[CUSTOMER][NEUTRAL] OK. And did you receive it? Could you please check it and please give me the information?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK. And what is the pay rate?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Visa
[AGENT][NEUTRAL] OK, I'm not showing that we've received the primary EOB at this time, but that address is is correct. So if you said you mailed it on the [PII], I would allow more time for us to receive it.
[CUSTOMER][NEUTRAL] Mailing
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK. How much that uh turnaround time did you need to receive it?
[AGENT][NEUTRAL] Uh, we can't, you know, gauge when we're going to receive it because it was from your office, so it's just uh based on the mail carrier.
[AGENT][NEUTRAL] But once we receive it, the standard processing time is 7 to 10 days.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Any other questions?
[CUSTOMER][NEUTRAL] No, reference number, please.
[AGENT][NEUTRAL] My name is today's date.
[CUSTOMER][POSITIVE] OK, thanks for providing the details. Have a nice day. Bye-bye, sir. No, nice talking to you.
[AGENT][POSITIVE] Oh, you're welcome, [PII]. Thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Bye-bye.