AccountId: 011433970860
ContactId: b99e5d78-554f-4b4a-9ede-756661440a6f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 661929 ms
Total Talk Time (AGENT): 179668 ms
Total Talk Time (CUSTOMER): 208481 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/b99e5d78-554f-4b4a-9ede-756661440a6f_20250306T19:59_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], I'm here to know the claim status of one of the members. Uh, you can help me with that?
[AGENT][NEUTRAL] I'm sorry, I did not understand what you asked.
[CUSTOMER][NEUTRAL] My name is [PII] calling from the provider's office and I'm here to know the claim status of one of the members I have.
[AGENT][NEUTRAL] OK. OK. You said that your name is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] [PII], it's [PII]
[AGENT][NEUTRAL] Thank you and [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] with the extension [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you and [PII], you're needing claim status for one patient, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, I can help you with that. And [PII], what is the member's policy number?
[CUSTOMER][NEUTRAL] Please note, it's 01611680 M as Mica, L as Lima, 8.
[AGENT][POSITIVE] OK, thank you one moment please.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And [PII], any information that is provided would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, official name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, [PII]. Thank you. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the date of service please and total bill amount?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, data service is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm so
[AGENT][NEUTRAL] I'm sorry, your voice went out. I heard [PII].
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] 2
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and the bill amount?
[CUSTOMER][NEUTRAL] $440.26.
[AGENT][NEUTRAL] 440.26. Is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] And the name of the provider group?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um, sorry, what is that?
[AGENT][NEUTRAL] What is the name of the provider group?
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] It's uh metric Medical LLC.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So this claim was received, the received date.
[AGENT][NEUTRAL] It's going to be
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] 528, 2024.
[AGENT][NEGATIVE] And it was processed and denied.
[CUSTOMER][NEUTRAL] I'm sorry, what did you say?
[AGENT][NEUTRAL] The claim was received on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Denied on [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The claim number is 346-0865.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the reason for the denial states outpatient benefit for this calendar year has been met.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, may you please repeat that? What's that?
[AGENT][NEUTRAL] I'm sorry, I didn't understand you, [PII].
[CUSTOMER][NEUTRAL] May you repeat that, please? Dear reason, what is the denial reason?
[AGENT][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] Outpatient benefits for this calendar year has been met.
[CUSTOMER][NEUTRAL] Oh, for this year has been met, right?
[AGENT][POSITIVE] Yes, for this calendar year has been met. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEUTRAL] Um, give me.
[CUSTOMER][NEUTRAL] Uh, timely filing limit of, uh, the patients.
[AGENT][NEUTRAL] Uh, I'm sorry, what was your question?
[CUSTOMER][NEUTRAL] Uh, let me know the timely filing limit of this.
[AGENT][NEUTRAL] For an appeal or an initial claim.
[CUSTOMER][NEUTRAL] For this I guess.
[AGENT][NEUTRAL] I'm sorry, your voice is cutting out, [PII].
[CUSTOMER][NEUTRAL] I said for this claim, I need timely filing limit or?
[AGENT][NEUTRAL] For an initial claim to be filed with APL, for an initial claim to be filed with APL, there is no timely filing. An appeal must be filed within 180 days from the date of the denial.
[CUSTOMER][NEUTRAL] The I.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, may you please hold for a minute for me?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] I have some queries today.
[CUSTOMER][NEUTRAL] Are you able to hold for one minute?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, OK I think just give me a moment, OK? I'll be there.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you, [PII] for.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] I'm sorry, [PII], I wasn't able to understand what you said.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] And thank you so much for your, uh, for your precious time.
[AGENT][POSITIVE] Oh, you're welcome. And if you.
[AGENT][POSITIVE] Yes, ma'am. You're welcome. And if you need a copy of this explanation.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] They.
[AGENT][NEUTRAL] You should have benefits, you may print it by going to our portal he. [PII] is secured. [PII].
[CUSTOMER][NEUTRAL] I'm sorry, what you said?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there anything else that I can help you with today?
[CUSTOMER][NEGATIVE] I, uh, I have a lot of concern.
[CUSTOMER][NEUTRAL] I have a last confirm that uh this member is eligible on the service, uh.
[AGENT][NEUTRAL] Yes, ma'am, they were.
[CUSTOMER][NEUTRAL] Are you able to check that?
[AGENT][NEUTRAL] I'm sorry, [PII], your voice is not audible at times. What was your question?
[CUSTOMER][NEUTRAL] Uh, my question is that, uh, is this, are you able to check that if this member is eligible on date of service or not?
[AGENT][NEUTRAL] Yes, ma'am. I said that they were.
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, [PII]. Thank you so much for your time and uh I just have to end this call. Uh, may you please tell me the reference number of our
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am. You would use my name along with today's date.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK. What about?
[CUSTOMER][NEUTRAL] Your name is [PII], right?
[AGENT][NEUTRAL] Actually, I spell it [PII].
[CUSTOMER][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK. Uh,
[CUSTOMER][POSITIVE] OK. So thank you so much for your time.
[AGENT][POSITIVE] Oh, you're welcome. Yes, ma'am. You're very welcome. So if that is all I can help you with, thank you again for calling APL [PII], and I hope you have a nice rest of your day also.
[CUSTOMER][POSITIVE] That's great too.
[CUSTOMER][POSITIVE] You too. Thank you.
[AGENT][POSITIVE] Thank you. You're welcome.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Bye.