AccountId: 011433970860
ContactId: bc7ab322-5e7d-45f9-a125-1e1d9dd58cd1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 423709 ms
Total Talk Time (AGENT): 156330 ms
Total Talk Time (CUSTOMER): 237482 ms
Interruptions: 8
Overall Sentiment: AGENT=0.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/31/bc7ab322-5e7d-45f9-a125-1e1d9dd58cd1_20241231T15:54_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, [PII], this is [PII], and my initial C for Charlie. Uh, I need your assistance to check the clients I've gone from the office.
[AGENT][NEUTRAL] You're needing to check claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I can help you, [PII]. What's the policy number?
[CUSTOMER][NEUTRAL] Uh, that would be 0166.
[CUSTOMER][NEUTRAL] 5263 M. like Mike L like Lima.
[CUSTOMER][NEUTRAL] 7. can I have your good name, misspell? I didn't got to clear. Yeah, we'll get you. What's your name?
[AGENT][NEUTRAL] And I get
[AGENT][NEUTRAL] Let me get, let me get your phone number.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Do you wanna repeat? OK. I.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, my name is [PII].
[CUSTOMER][NEUTRAL] Can
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] ONYA.
[AGENT][NEUTRAL] And first initial of my last name is [PII].
[CUSTOMER][NEUTRAL] What's the?
[CUSTOMER][POSITIVE] Thank you so much for your details. Patient is [PII], [PII].
[AGENT][NEUTRAL] OK, and what's the patient's name and date of birth?
[AGENT][NEUTRAL] Thank you for that and you said that you're checking claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, provide the date of service and the total charge please.
[CUSTOMER][NEUTRAL] [PII], [PII].
[CUSTOMER][NEUTRAL] Total charge is $813 813.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] Take time.
[CUSTOMER][NEUTRAL] The member ID is 21198292.
[CUSTOMER][NEUTRAL] The member's first name [PII] and the last name, your date of birth [PII].
[CUSTOMER][NEUTRAL] Any.
[AGENT][NEUTRAL] All right, so the claim was received [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Process date is [PII].
[AGENT][NEUTRAL] I'm showing no payment was made on this claim. Uh, the inpatient maximum benefit for this calendar year has been met.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's just an office visit, right? Uh, you're no longer pro, uh, sorry, you're no longer processing that services.
[AGENT][NEUTRAL] The inpatient was that an inpatient claim?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] What's the services, sir. Please give me a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 3650.
[CUSTOMER][NEGATIVE] No, for the same service, I got a payment rate for all the data service. Why you are telling it was the maximum.
[AGENT][NEGATIVE] The maximum inpatient benefit is exhausted. By the time we received that claim, there were no more benefits available.
[CUSTOMER][NEUTRAL] OK. Those benefits are accessed by visit wise or dollar wise.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] I said then I'll visit.
[AGENT][NEUTRAL] The dollar maximum has been met.
[CUSTOMER][NEUTRAL] Yeah. OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me know when you're ready for the claim number.
[CUSTOMER][NEUTRAL] Give me a sec.
[CUSTOMER][NEUTRAL] Uh, please give me a moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, may I know the minimum dollar amount or how many it will be applied?
[AGENT][NEUTRAL] The maximum inpatient benefit per calendar year is $1500.
[CUSTOMER][NEUTRAL] OK. Out of 1500, it was being complete limit, right?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] For 1500, it was completely met, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, should I need to bill a second due amount of $23.95 to the patient?
[AGENT][NEUTRAL] We do not determine patients responsibility, [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, then what do I need to do with the second mode.
[AGENT][NEUTRAL] We cannot advise that's totally up on to the provider's office. It's, it's, we couldn't pay anything because their maximum benefit is exhausted or met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, mini.
[CUSTOMER][NEUTRAL] OK. Thank you. Is there any chance that I can go with the pill?
[AGENT][NEUTRAL] Uh, you are more than welcome to submit the appeal, but it'll be denied because the benefit is exhausted.
[CUSTOMER][NEUTRAL] I do have your mailing address for [PII]. OK, [PII]. Uh, and the fax, I have [PII]. Is this the one?
[AGENT][NEUTRAL] Correct, the mailing address is a PO box.
[CUSTOMER][NEUTRAL] Uh yeah, I do, uh, just, just want to add, OK, claim number.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That number is 353-010-8 and any other questions, [PII]?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] I do have 3530108, right? Uh, can I request you a copy of EOB for this one to my fax and denied one.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yeah we've already mailed it the next day after it was processed. It's now available to download on our online service center. Let me know when you're ready for that web address.
[CUSTOMER][NEUTRAL] No, I do have that information. Just confirm once have you send this provider or not.
[AGENT][NEUTRAL] Yeah, I can assist you with downloading it from our online service center if you would like.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] OK, so you'll go to [PII].
[CUSTOMER][NEUTRAL] see
[CUSTOMER][NEUTRAL] [PII]. What? Am
[AGENT][NEUTRAL] The word [PII]
[CUSTOMER][NEUTRAL] [PII] OK, then.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I can't get that. What, what was that? Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, then where do I need to go?
[AGENT][NEUTRAL] OK, and so you should be on it says online service center welcome.
[AGENT][NEUTRAL] It's the home page?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, I got that. Thank you. Call the fence.
[AGENT][NEUTRAL] And so you would click on the new user tab to the right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you would describe uh select which role best describes you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then click the next button.
[CUSTOMER][POSITIVE] Thank you so much for the information.
[AGENT][NEUTRAL] And so here it's asking you to verify the provider tax ID number on this claim and the patient account number on the claim form that was submitted by this office.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 3
[CUSTOMER][POSITIVE] Thank you so much. Thanks. Go ahead with the call references.
[AGENT][NEUTRAL] It's my name in today's date.
[CUSTOMER][POSITIVE] Thank you, [PII]. Hope you have a good holiday. Bye-bye. Take care.
[AGENT][POSITIVE] Yeah, you're welcome and thank you [PII] for calling APL. Have a good day.