AccountId: 011433970860
ContactId: bdacafc4-ca8c-4456-81f5-c8bd112b3cb1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 239779 ms
Total Talk Time (AGENT): 84058 ms
Total Talk Time (CUSTOMER): 80941 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/bdacafc4-ca8c-4456-81f5-c8bd112b3cb1_20250527T17:24_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from Allergy Partners. Um, I was calling because I wanted to get a claim status.
[AGENT][POSITIVE] OK, well, I can definitely help you with the claim status. And for my notes, can you spell your first name for me please and provide a good contact number?
[CUSTOMER][NEUTRAL] Uh yes, it's [PII]
[CUSTOMER][NEUTRAL] And a good phone number is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Uh yes, member ID number is gonna be, sorry, 01896422.
[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] [PII] and date of birth is [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 and the total bill for the claim?
[CUSTOMER][NEUTRAL] Uh, yes, the data service is gonna be [PII], and the total bill is $52.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Um, on the claim, it's allergy Partners.
[AGENT][NEUTRAL] OK, here it is.
[AGENT][NEUTRAL] Alright, so it's showing the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 358.
[AGENT][NEUTRAL] 2251.
[AGENT][NEUTRAL] And on [PII], the claim was denied?
[AGENT][NEUTRAL] Um, because the outpatient benefit for the calendar year has been met.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, [PII], was there anything else I can assist you with today? Oh, go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] So is that, no, no, I'm sorry. Is that leaving the balance to the patient responsibility?
[AGENT][NEUTRAL] Um, so we
[CUSTOMER][NEUTRAL] After
[AGENT][NEUTRAL] Primary.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So we don't determine.
[CUSTOMER][NEUTRAL] So the 1345 is staying at the patient. Oh, I'm so sorry. I don't mean to cut you off.
[AGENT][NEUTRAL] It's OK. Oh, it's OK. Uh, we don't determine patient responsibility because we're not the major medical, um, so if there is something left over, it will be whatever your procedures are an outstanding balances or remaining balance.
[CUSTOMER][NEUTRAL] OK, because the primary did process leaving the [PII] to patient responsibility.
[CUSTOMER][NEUTRAL] And then we forward the the claim went over to you all.
[CUSTOMER][NEUTRAL] And then you guys denied it for outpatient benefit for calendar year, OK.
[AGENT][NEUTRAL] Alrighty. Well, was there anything else I can help you with today?
[CUSTOMER][POSITIVE] I know that was all. Thank you so much for your help. Oh wait, I'm sorry, is there a reference number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK, perfect. Thank you so much. Have a great day.
[AGENT][POSITIVE] You also, thanks for calling APL [PII]. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.