AccountId: 011433970860
ContactId: c7dcbd96-b79e-46c4-b1ec-dbd54323b859
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 515217 ms
Total Talk Time (AGENT): 127388 ms
Total Talk Time (CUSTOMER): 124798 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/c7dcbd96-b79e-46c4-b1ec-dbd54323b859_20250221T15:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII] from provider's office to check the client status. Would be able to help me today?
[AGENT][POSITIVE] Yeah, I'm happy to check on a claim for you today. Do we have a patient, uh, policy number?
[CUSTOMER][NEUTRAL] Sure. The policy number for the patient is
[CUSTOMER][NEUTRAL] One moment, let me check that. My system had got stuck over here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Please give me 30 to 45 seconds.
[AGENT][POSITIVE] No problem.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, I do have the policy number.
[CUSTOMER][NEUTRAL] Upon checking here, there is no proper policy number that has been found over here. Let me check once again.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, here it is mentioned that 60801. No other details has been mentioned over here. So be able to check with the patient's first and last name.
[AGENT][NEUTRAL] Yeah, what's the first and last name?
[CUSTOMER][NEUTRAL] Uh, the first name is [PII]. That is, let me spell that, that is [PII]. And last name is [PII], that is [PII].
[AGENT][POSITIVE] Alright thank you so much one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] OK. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for that and then what is the date of service?
[CUSTOMER][NEUTRAL] Date of service for the claim is [PII] and the total charges is $990 even.
[AGENT][NEUTRAL] Did you need the policy number?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Policy number is 02433261.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so it looks like we did receive this claim [PII].
[AGENT][NEUTRAL] Uh, the claim was denied.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The outpatient benefit max for the calendar year had already been met.
[CUSTOMER][NEUTRAL] Outpatient benefits has been met for the calendar year, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So how many units, uh, how many visits are allowed per gallon per year?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Uh, the outpatient benefit maximum for the calendar year under this plan is $4000.
[AGENT][NEUTRAL] [PII], are you still there?
[CUSTOMER][NEUTRAL] And when it has been met?
[AGENT][NEUTRAL] Um, it looks like the last date, uh, it was on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, but the date of service for the claim is [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So then we'll be able to send back this for rep process then because the date of service was last mid [PII], right?
[AGENT][NEUTRAL] Right, but I'm saying the last claim that a benefit was paid on was on the [PII]. I don't know what the date of service was. I can pull that up for you one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the date of service was for [PII] when the benefits were exhausted.
[AGENT][NEUTRAL] Uh, this claim was just submitted prior to the [PII]. That's why it was paid. This claim is not valid for resubmission.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's fine, then it is purely patient responsibility, right?
[AGENT][NEUTRAL] We're not able to advise on that that's up to the facility or provider.
[CUSTOMER][NEUTRAL] OK. That's fine. What's the claim number?
[AGENT][NEUTRAL] 354-594-8
[CUSTOMER][NEUTRAL] OK, we have not received the explanation of benefits. So were you able to send me through the uh fax?
[AGENT][POSITIVE] Absolutely. What's a good fax number?
[CUSTOMER][NEUTRAL] Fax number is [PII].
[AGENT][NEUTRAL] Should we mark attention to anybody?
[CUSTOMER][NEUTRAL] To my name, [PII].
[AGENT][POSITIVE] OK job.
[AGENT][NEUTRAL] Right, that's on its way. It should be there in about 5 minutes. Is there anything else I can check on for you today?
[CUSTOMER][NEUTRAL] That's all for today's call, and what would be the call for the call?
[AGENT][NEUTRAL] Call references my name with my last initial and then today's date. My name again is [PII], that's [PII] My last initial is [PII].
[CUSTOMER][POSITIVE] Thank you, sir. Have a great rest of your day to you today.
[AGENT][NEUTRAL] You too [PII] bye bye.