AccountId: 011433970860
ContactId: c00b45db-970a-4227-8c2f-36a75fbe5c5f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 420420 ms
Total Talk Time (AGENT): 82968 ms
Total Talk Time (CUSTOMER): 157781 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/c00b45db-970a-4227-8c2f-36a75fbe5c5f_20250221T21:47_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, hi, so this is [PII]. I'm calling from the provider's office to check on, uh, fact that we had sent, uh, regarding a claim, uh, for a patient as, uh, they were requesting the primary UB. I'm just calling on to check if you have received that or not.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] If, if we have received what I'm sorry?
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] Uh, uh, I'm just calling in to check out if, uh, I mean a fax was sent by us, uh, to American Public Life regarding a patient for, uh, as the payer request of the primary OB.
[AGENT][NEUTRAL] OK. Um, may I have your name?
[CUSTOMER][NEUTRAL] Yes, it's [PII], it's [PII]
[AGENT][NEUTRAL] OK, may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK, and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] of
[CUSTOMER][NEUTRAL] Uh, the patient's policy number is, um, it's 34873778.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] I'm a guy.
[AGENT][NEUTRAL] The number you're providing me, is that the um
[AGENT][NEUTRAL] The claim number or the policy number? What's that?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 00, I'm.
[CUSTOMER][POSITIVE] I'm so sorry about that.
[CUSTOMER][NEUTRAL] Uh, yes, I provided the wrong number. The policy number is, it's 1335.
[CUSTOMER][NEUTRAL] 660
[CUSTOMER][NEUTRAL] [PII] 8.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] The patient's name is, it's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Uh, the date of service is [PII], and the total charges are $37,588 even.
[AGENT][NEUTRAL] OK, it's gonna be a minute.
[AGENT][NEUTRAL] OK, looks like the um the ELB was received on [PII], processed [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim was denied. The reason for this denial is that outpatient maximum for the date of service has been met.
[CUSTOMER][NEUTRAL] OK, patient, OK, uh, maximum benefit has been met for the outpatient, right?
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, uh, so would that be, uh, the patient responsibility?
[AGENT][NEUTRAL] It's up to the provider's discretion. We don't have any um involvement on the remaining of the claim, so it's just gonna be up to the provider's discretion.
[CUSTOMER][NEUTRAL] I didn't
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, OK, all right. So, and you said the claim was received on, uh, I mean the year we was received on [PII], right, and processed on to [PII].
[AGENT][NEUTRAL] OK, bear with me, let me pull that again, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it was processed on [PII].
[CUSTOMER][NEUTRAL] [PII]. I'm sorry, and it was received on the [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Uh, could you please help me out with the claim number?
[AGENT][NEUTRAL] Mhm sure.
[AGENT][NEUTRAL] The claim number is 3562693.
[CUSTOMER][NEUTRAL] 26
[CUSTOMER][NEUTRAL] OK. Um.
[CUSTOMER][NEUTRAL] Uh, no, would you please, uh, fax the COB to us?
[AGENT][NEUTRAL] What's the fax number?
[CUSTOMER][NEUTRAL] Mm, the fax number is just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] To your attention.
[CUSTOMER][NEUTRAL] Uh, to my attention, yes.
[AGENT][NEUTRAL] OK, can you spell your name?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, it's [PII] initial to my last name is [PII].
[AGENT][NEUTRAL] OK, do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][NEUTRAL] OK, that's uh that's all right, yeah, I, I mean, uh, I have other, uh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I mean other calls uh can you please, uh.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Hello
[CUSTOMER][NEUTRAL] I mean, yeah, that's fine. I can be on the hold.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.