AccountId: 011433970860
ContactId: c889ae2b-1a4a-4f81-9fce-ef1e3d5ff60d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 274989 ms
Total Talk Time (AGENT): 125316 ms
Total Talk Time (CUSTOMER): 48614 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/c889ae2b-1a4a-4f81-9fce-ef1e3d5ff60d_20250218T16:30_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I'm calling from Ensemble on behalf of Curan Clinic. How are you?
[AGENT][NEUTRAL] I'm fine. And did you say your name is [PII]? Is that correct?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Oh, I am so sorry, [PII]. I'm so sorry. Yes, ma'am. How can I help you today, [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] I just wanted to check the status of a claim please.
[AGENT][NEUTRAL] OK, so you have one patient that you're needing to check claim status for, is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Yes ma'am, I can help you and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII] direct number.
[AGENT][NEUTRAL] Thank you. And the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] It is 024909997.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you one moment.
[AGENT][NEUTRAL] Thank him and the information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth, please?
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for him, please?
[CUSTOMER][NEUTRAL] [PII] 2024
[CUSTOMER][NEUTRAL] And the amount of
[CUSTOMER][NEUTRAL] $4,238
[AGENT][NEUTRAL] OK, again, that was 79 2024 for $4,238. Is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this claim was received date [PII].
[AGENT][NEUTRAL] It was processed and denied on 8-27-2024.
[AGENT][NEUTRAL] The claim number is 349-8176.
[AGENT][NEUTRAL] Um, one moment, I'll give you the denial remark.
[AGENT][NEUTRAL] OK, so it states the calendar year maximum for the accident and sickness surgery benefit performed in a hospital, hospital outpatient facility, or freestanding outpatient surgery center has been met for this calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you need a copy.
[CUSTOMER][POSITIVE] All right. Good to know.
[AGENT][POSITIVE] Oh, I'm so sorry. I didn't mean to interrupt you, [PII].
[CUSTOMER][MIXED] No worries. Um, all right, so it's denied because your Max had been met already.
[AGENT][POSITIVE] That is correct, yes ma'am.
[AGENT][NEUTRAL] And if you need a copy of that explanation of benefits with those remarks, [PII], you can go to our portal that's secured.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And you should be able to print a copy of that now that you have the um excellent excuse me, the claim number.
[CUSTOMER][POSITIVE] OK. All right. I appreciate your help today, [PII]. Is there a call reference number for today?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] Yes, ma'am. You would just use my name along with today's date.
[CUSTOMER][NEUTRAL] OK. All right.
[AGENT][POSITIVE] OK. All right. Well, if that's all then [PII] that I can help you with, thank you again for calling APL and I hope you have a wonderful day.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] Thank you. Bye-bye.