AccountId: 011433970860
ContactId: b8348bf7-c7a4-4d60-8e58-c0fa5a6e0aca
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 576330 ms
Total Talk Time (AGENT): 175745 ms
Total Talk Time (CUSTOMER): 245723 ms
Interruptions: 10
Overall Sentiment: AGENT=1.1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/b8348bf7-c7a4-4d60-8e58-c0fa5a6e0aca_20250130T17:12_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm [PII] calling on behalf of desk office. By the way, how are you doing today?
[AGENT][POSITIVE] I'm doing well, [PII]. How are you?
[CUSTOMER][POSITIVE] Yes, I'm good as well. Thanks for asking.
[AGENT][POSITIVE] You're welcome. And how may I assist you today, [PII]?
[CUSTOMER][NEUTRAL] To check on the claim status.
[AGENT][NEUTRAL] Alright, and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] The only one claim.
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yes, uh, my callback number is [PII].
[CUSTOMER][NEUTRAL] And the policy number is 02.
[CUSTOMER][NEUTRAL] 191897.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] And the the patient's last name is [PII], uh last name is [PII] and uh that with this.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim you like me to check on?
[CUSTOMER][POSITIVE] Thank you for that.
[CUSTOMER][NEUTRAL] Yes, the NetA service is [PII].
[CUSTOMER][NEUTRAL] And the bill amount is?
[CUSTOMER][NEUTRAL] $90.59.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] hold on
[AGENT][NEUTRAL] And can you verify the name of the provider's office that would be on the claim?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] As the
[CUSTOMER][NEUTRAL] The offices one to podiatry.
[CUSTOMER][NEUTRAL] And the NPA group NPA is 102373.
[CUSTOMER][NEUTRAL] 4365.
[AGENT][NEUTRAL] You said Montgomery podiatry?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'm showing the claim was received on [PII].
[CUSTOMER][NEUTRAL] Some
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That that claim number is 3502273.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] And.
[AGENT][NEUTRAL] Because the calendar year maximum for outpatient visits has been met for the year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know the, how many visits to allow for the, for the CBT?
[AGENT][NEUTRAL] Not the CPT. 6 visits are allowed for the calendar year for the policy.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Upon checking in my system, the claim was
[CUSTOMER][NEUTRAL] The seats are only 1 May I know the remaining?
[CUSTOMER][NEUTRAL] 5 details on the billing details for uh.
[AGENT][NEUTRAL] I don't understand the question. Can you repeat that, please?
[CUSTOMER][NEUTRAL] And upon checking in my system, these patients only meet for the and upon the ledger.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] To meet the uh visit for only one visit only. May I know the
[CUSTOMER][NEUTRAL] Previous visit details.
[AGENT][NEUTRAL] No, no, we don't give the insured other claim information. By the time your claim came in, they had used all 6 visits, so we could not pay out on this claim.
[CUSTOMER][NEUTRAL] We don't give
[CUSTOMER][NEUTRAL] So we could not take on this.
[CUSTOMER][NEUTRAL] May I know the autoronic payer ID?
[AGENT][NEUTRAL] The payer ID is 60801.
[CUSTOMER][NEUTRAL] OK, thank you. Uh, may I place your call on in one minute?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thanks for being on hold. I really appreciate your patience.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And was there anything else I could assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yeah, I have already clarification about you, uh, clarification actually, upon checking your system, in our patients only made the one visit, sir, but, uh, how you are only told you should only only 6 visits are allowed there.
[CUSTOMER][NEUTRAL] May I know the remaining 5 visits are different?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Unfortunately, we cannot, we cannot give you other claim information pertaining to your claim. All 6 visits by the time your claim came in, the other 6 visits were used. We can't go through the other claims to see when the dates of when each visit was used. It's for the whole year.
[CUSTOMER][NEUTRAL] Yeah you are.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] OK, no problem. Uh, I'm just asking for the the same provider or different provider. That's why I'm asking. I'm not asking about the, uh, the remaining the details.
[CUSTOMER][NEUTRAL] Uh just to confirm the same provider or different provider to pay your previous receipts.
[AGENT][NEUTRAL] Right, and what I'm saying is I will have to go through all the claims to see what provider filed those claims.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] See what.
[AGENT][NEUTRAL] But that does it.
[CUSTOMER][NEUTRAL] But they do
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Uh, we don't give that information out, we just give you the information for your claim.
[CUSTOMER][NEUTRAL] Uh, we don't give that information.
[AGENT][NEUTRAL] I can't go through the other claims to see of the 6 visits if they were your provider or not.
[CUSTOMER][NEUTRAL] I plan to do.
[CUSTOMER][NEUTRAL] Up to 6 if they.
[AGENT][NEUTRAL] But for this claim,
[CUSTOMER][NEUTRAL] OK, uh, you are, you, yeah, I understand your words, but, uh, and upon checking the system, we, we are only the one BC to meet the payer providers that payer that's why I'm asking for you. You are the same provider or different provider to meet the previous visits.
[AGENT][NEUTRAL] They were used.
[AGENT][NEUTRAL] If in your system, you're only showing that you have that one claim, then we can go with that and the other claims were other providers, but I cannot give you other claim information to see when this this benefit was maxed. It was maxed when your claim was received.
[CUSTOMER][NEUTRAL] Bye
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] That's but I.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] The so actually this claimail us for maximum seats are finished. Yeah, I understand the uh answer.
[CUSTOMER][NEUTRAL] Well how can to solve this claim that's why I'm asking for you. Just I have clarify the information for different.
[CUSTOMER][NEUTRAL] Provider or same provider?
[AGENT][NEUTRAL] The only way to
[AGENT][NEUTRAL] The only way to resolve this claim would then be to see how your, how your, um,
[CUSTOMER][NEUTRAL] To see.
[AGENT][NEUTRAL] Provider deals with outstanding balances. What do you do when a claim has been denied, but I can't, that would be, however, what your procedures are.
[CUSTOMER][POSITIVE] Absolutely
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] May I place the call on hold one minute, please.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Thanks for being on hold. I really appreciate your patience.
[CUSTOMER][NEUTRAL] Could you please spell your name, please?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Mhm. My name is [PII]
[AGENT][NEUTRAL] First initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thanks
[CUSTOMER][NEUTRAL] OK. May I know the callback number, uh call reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name and today's date.
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] That's very wonderful last time. Have a great day.
[AGENT][POSITIVE] You also, thanks for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] You too thanks for calling. Thank you bye bye.