AccountId: 011433970860
ContactId: cb290434-9bfd-41e9-8264-a300eb2691b1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 262279 ms
Total Talk Time (AGENT): 108392 ms
Total Talk Time (CUSTOMER): 77125 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/cb290434-9bfd-41e9-8264-a300eb2691b1_20250214T18:45_UTC.wav
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[AGENT][NEUTRAL] For contacting APL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII] calling from provider's office to check the claim status.
[AGENT][NEUTRAL] Even I can help with the claim status. What is that policy number, please?
[CUSTOMER][NEUTRAL] Yeah, sure. The policy number is
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Yeah, thank you for that. Uh, the policy number is 01069881.
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yeah, the patient name is uh [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][POSITIVE] Thank you. If I can have a callback number please in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. The callback number is [PII] and extension will be [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] [PII]. Thank you. And what is that um data service that we're looking for for [PII]?
[CUSTOMER][NEUTRAL] Yeah, the date of service is uh [PII]. And the total charge amount is uh $584.71.
[AGENT][NEUTRAL] OK, thank you. I'm just checking now.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, thank you. Um, [PII], your claim number.
[AGENT][NEUTRAL] Is 347.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 0664. So it's 347.
[AGENT][NEUTRAL] 0664.
[AGENT][NEUTRAL] The claim was received.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Let's see, on the [PII].
[AGENT][NEUTRAL] We processed it on the [PII].
[AGENT][NEUTRAL] This policy.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Has 4 office visits for calendar year.
[AGENT][NEUTRAL] And by the time that we had received your claim, all 4 of those office visits had been used.
[AGENT][NEGATIVE] So the office visits um benefits had been used by the time we received your, your, uh, claims, so that's why it was denied.
[AGENT][NEUTRAL] And it was denied because those four office visits had already been used up for the calendar year [PII].
[AGENT][NEUTRAL] And so that's, you'd probably want to talk to the insured about this um because it's those, those benefits had already been used.
[AGENT][NEUTRAL] And by the time we receive your claim, yeah.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] All right. Uh, so,
[CUSTOMER][NEUTRAL] All right. Uh, how much, uh, the entire allowed amount is, uh, denied, right?
[AGENT][NEGATIVE] Yes, it's all denied because the all the benefits have been used for that calendar year.
[CUSTOMER][NEUTRAL] Yeah, uh, could I get the, how much is the allowed amount?
[AGENT][NEUTRAL] Whether it would have been, we would have paid $25 for 4 office visits per calendar year and that's just a verification, not a guarantee of payment, but all four of those benefits have been used.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] All right. Uh, so.
[CUSTOMER][NEUTRAL] All right. Uh, could I get the
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] On which date the patient has made?
[AGENT][NEUTRAL] It was on, uh, it looks like that was met on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is there anything else I can help with?
[CUSTOMER][NEUTRAL] Mm, no, no, no. And could I get the call reference number for this call?
[AGENT][NEUTRAL] Yes, my name is [PII]. The first letter of my last name is [PII], and we're gonna use that today's date as a reference.
[CUSTOMER][POSITIVE] All right. Thank you for that.
[AGENT][POSITIVE] OK. Thanks for contacting APL. Have a very good day.