AccountId: 011433970860
ContactId: c928e941-190c-4751-a047-ee40c3ac4931
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 290480 ms
Total Talk Time (AGENT): 81011 ms
Total Talk Time (CUSTOMER): 118221 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/c928e941-190c-4751-a047-ee40c3ac4931_20250617T21:11_UTC.wav
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[CUSTOMER][NEUTRAL] Really
[AGENT][NEUTRAL] Good afternoon calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from the provider office to check the claim status. Previously, we uh we have talked.
[AGENT][POSITIVE] OK, and I'll be more than happy to help you with the claim status, [PII]. May I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, the contact number is [PII].
[AGENT][NEUTRAL] Thank you. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, the members.
[CUSTOMER][NEUTRAL] Policy number.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It's 0249.
[CUSTOMER][NEUTRAL] 6550.
[CUSTOMER][NEUTRAL] M for Marvel, L for Louis, 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient's last name is [PII] and the first name is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII].
[CUSTOMER][NEUTRAL] And the total charge amount is $20,820 even.
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh yeah, yeah, the provider's last name is [PII] and the first name is [PII].
[CUSTOMER][NEUTRAL] And uh her doctor's office name is?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah, the doctor's Kendall Anesthesia Associates.
[AGENT][NEUTRAL] Thank you for that. So I'm showing the claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3597898.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because the outpatient benefit for the calendar year has been met.
[CUSTOMER][NEUTRAL] Sorry, is it a is it value or dollar value?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] This is speaking of dollar value, so it's saying that the calendar year max has been used.
[CUSTOMER][NEUTRAL] OK. Uh, is there any other insurance for this patient?
[AGENT][NEUTRAL] Um, yes, their primary insurance is United Healthcare.
[CUSTOMER][NEUTRAL] Yes, the primary and the secondary is American Life Insurance.
[AGENT][NEUTRAL] American Public Life, we are the secondary, yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, uh.
[CUSTOMER][NEUTRAL] But how much uh uh
[CUSTOMER][NEUTRAL] How much value he has met uh for the previous year.
[AGENT][NEUTRAL] So this is saying for [PII], he's used the full $1500.
[CUSTOMER][NEUTRAL] How much?
[AGENT][NEUTRAL] $1500 is the calendar year max for outpatient expenses.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Yeah, OK, OK, thank you.
[CUSTOMER][NEUTRAL] There is no other insurance.
[CUSTOMER][NEUTRAL] The maximum benefit existed. OK, can you please give me the call reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. First initial and my last name is [PII].
[CUSTOMER][POSITIVE] Yeah, OK. Thank you. Thank you for assisting me for today, OK.
[AGENT][POSITIVE] You're welcome, [PII]. Thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.