AccountId: 011433970860
ContactId: c920dfec-a287-41a6-837a-68a98ede9eb6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 397940 ms
Total Talk Time (AGENT): 140089 ms
Total Talk Time (CUSTOMER): 110617 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/c920dfec-a287-41a6-837a-68a98ede9eb6_20250115T20:03_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] Hello, this is [PII] speaking from the provider's office.
[AGENT][POSITIVE] Good afternoon, [PII]. How are you doing today?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] I'm actually doing very well, thank you for asking. Uh, so,
[CUSTOMER][NEUTRAL] So, I'm calling regarding a claim status. So before we get started, I just wanted to inform that this call is being recorded for quality and training purposes. Can we continue?
[AGENT][POSITIVE] Yes sir, it would be my pleasure to assist you with claim status. What is a good call back number please?
[CUSTOMER][NEUTRAL] It would be [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number of the patient?
[CUSTOMER][NEUTRAL] 02221656 M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And your date of birth, please.
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][POSITIVE] All right, thank you. [PII] it would be my pleasure to assist you with that claim status. Do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] Yes, the claim number would be 3484466.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is that data service and build amount?
[CUSTOMER][NEUTRAL] [PII] and bill amount is $750 even.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And you have the EOB requesting the primary EOB correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Looks like we did receive that on 123-24.
[AGENT][NEUTRAL] And processed on 126-24.
[AGENT][NEUTRAL] And the claim was denied.
[AGENT][NEUTRAL] And that denial reason was the outpatient benefit for the calendar year has been met.
[CUSTOMER][NEUTRAL] OK. So,
[AGENT][NEGATIVE] So benefits are not payable.
[CUSTOMER][NEUTRAL] OK, but, uh, OK.
[CUSTOMER][NEUTRAL] So what is the uh outpatient benefit the patient has?
[AGENT][NEUTRAL] On this policy, the outpatient benefit max.
[AGENT][NEUTRAL] And that is a per calendar year benefit is $3500.
[CUSTOMER][NEUTRAL] OK. And when was it last met?
[AGENT][POSITIVE] That benefit maxed out on, let me get that information for you.
[CUSTOMER][NEUTRAL] Yes. Last, when was it paid for this member?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, give me just one second.
[AGENT][NEUTRAL] Getting that information.
[CUSTOMER][NEUTRAL] Can I have your name till then?
[AGENT][NEUTRAL] Sure. My name is [PII]
[AGENT][NEUTRAL] First initial last name.
[CUSTOMER][NEUTRAL] And initials to
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And I'm still checking on that, so bear with me just one second.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Well, this is a very nice name, like a unique one. I've, I've never heard. Yeah.
[AGENT][POSITIVE] Well, thank you.
[AGENT][NEUTRAL] Never heard [PII].
[CUSTOMER][NEGATIVE] Not this pronunciation, no.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let's see, I'm still getting that information. Bear with me just one moment.
[AGENT][NEUTRAL] It looks like that maximum benefit was paid out on.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Can I get the new claim number and the call reference number?
[AGENT][NEUTRAL] The new claim number for your claim is 353.
[AGENT][NEUTRAL] 7996.
[CUSTOMER][NEUTRAL] As a call reference?
[AGENT][NEUTRAL] My name in today's date.
[CUSTOMER][NEUTRAL] [PII] with
[CUSTOMER][NEUTRAL] [PII]. All right. There's one more patient that I would like to speak about.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] All right. If you would just give me one quick moment, [PII], to complete the notation of this account.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Won't take me but just a second.
[AGENT][NEUTRAL] All right, [PII]. I am ready for that next policy number. What is that number?
[CUSTOMER][NEUTRAL] Just a second.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I guess that's it for today.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Just, yeah, that's it for today. That's it, actually. That's it. I, my bad.
[AGENT][NEUTRAL] Well, it's
[AGENT][NEUTRAL] With
[AGENT][POSITIVE] No, no problem at all. It's been a pleasure to assist you with that claim status, [PII]. Thank you for calling APL. I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] Same to you [PII].
[AGENT][POSITIVE] Thank you. Take care.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] Bye bye