AccountId: 011433970860
ContactId: c3633c2a-dce9-4276-92d0-340211d1b1e6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 236080 ms
Total Talk Time (AGENT): 54842 ms
Total Talk Time (CUSTOMER): 75209 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/2025/03/06/c3633c2a-dce9-4276-92d0-340211d1b1e6_20250306T19:13_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, hi [PII]. My name is [PII] calling from provider's office for the claim status. Could you please help me with that?
[AGENT][NEUTRAL] I can help you [PII]. What's the policy number?
[CUSTOMER][NEUTRAL] Yes, sir, and please be advised this call has been recorded for quality and training purpose.
[CUSTOMER][NEUTRAL] And the member ID is 02510281.
[AGENT][NEUTRAL] And your phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Oh sure.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Sure. It is [PII], [PII].
[AGENT][NEUTRAL] What phone number did you dial [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Uh, actually, I, I received the, we received the UB, but we, uh, I need to confirm on the denial reason.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, do you have a claim number?
[CUSTOMER][POSITIVE] Yes, I do have one.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 355-8386
[AGENT][NEUTRAL] And do you have a copy of the explanation of benefits there in front of you?
[CUSTOMER][NEUTRAL] Uh yes.
[AGENT][NEUTRAL] OK. And do you turn to the back of the EOB?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It's not showing, ma'am. Just it is showing as denied, but I don't have the denial reason on that.
[AGENT][NEUTRAL] OK. So it's the calendar year maximum for outpatient accident and sickness treatment in the emergency room has been met. That's on the back of the explanation of benefits.
[CUSTOMER][NEUTRAL] OK. And the whole amount is patient responsibility, is that right, ma'am?
[AGENT][NEUTRAL] We do not determine patients responsibility. I can just say that the calendar, your maximum for that service is exhausted.
[CUSTOMER][NEUTRAL] OK, maximum benefit met for the calendar year. Is that right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And um is there any discount applied on this?
[CUSTOMER][NEUTRAL] Provide a discount.
[AGENT][NEUTRAL] Uh, you may contact Multiplan to verify that information.
[CUSTOMER][NEUTRAL] OK. And um
[CUSTOMER][NEUTRAL] That's it, ma'am. Your name is [PII], right?
[AGENT][NEUTRAL] Uh huh and first initial last name is [PII]. Use my name in today's state as your reference for today's call. [PII], any other questions I can help out with today?
[CUSTOMER][POSITIVE] Uh, no, ma'am. That's it. Thank you so much for assisting and have a great day. Bye-bye.
[AGENT][POSITIVE] Well, you're welcome. Thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Good day, thank you.