AccountId: 011433970860
ContactId: cca5a0d3-6c04-4637-ab41-8096b218a89d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1378849 ms
Total Talk Time (AGENT): 292299 ms
Total Talk Time (CUSTOMER): 229078 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/23/cca5a0d3-6c04-4637-ab41-8096b218a89d_20250623T13:43_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is So. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from the doctor's office to check on our claim status.
[AGENT][NEUTRAL] Yeah, I can hardly hear you. Can you repeat your name?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] You're breaking up. Can you repeat your name?
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] Are you saying no?
[CUSTOMER][POSITIVE] Yes, you're right.
[AGENT][NEUTRAL] How do you spell that?
[CUSTOMER][NEUTRAL] [PII], and my last name is [PII].
[AGENT][NEGATIVE] OK, I'm having a really hard time hearing you.
[AGENT][NEUTRAL] Sounds like you're coming in and out of your headset.
[AGENT][NEUTRAL] I got [PII]. What is the next in the next letter?
[CUSTOMER][NEUTRAL] Your ma'am, right?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and may I have a callback number just in case we get disconnected, Mr. No.
[CUSTOMER][NEUTRAL] [PII]. And the extension is [PII].
[AGENT][NEUTRAL] [PII]. OK, and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 785-511
[AGENT][NEUTRAL] And may I have the name of the facility you're calling from, Mr. No?
[CUSTOMER][NEUTRAL] Optional clinic
[AGENT][NEUTRAL] Arsenal
[CUSTOMER][NEUTRAL] A clinic, yes.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] The patient's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, Mr.
[AGENT][NEUTRAL] Um, what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Uh, we are looking for the date of service is [PII]. And the charge amount is $969 even.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] That is [PII] for 969.
[CUSTOMER][POSITIVE] Yes, you're right.
[AGENT][NEUTRAL] OK, let me see if I can find this claim for future. You can check claim status online through our website at [PII].
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] OK, let me pull this EB one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm still waiting on the system.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it looks like we processed the claim [PII].
[AGENT][NEUTRAL] And the claim was denied?
[AGENT][NEUTRAL] The reason for this denial is that outpatient benefits for the calendar year has been exhausted.
[CUSTOMER][NEUTRAL] So it is exhausted under visit wise, right?
[CUSTOMER][NEUTRAL] May I know how many visits for call per year?
[AGENT][NEUTRAL] OK, let me check and see. It's gonna be the dollar amount.
[AGENT][NEUTRAL] And this is not a guarantee of payment, just a verification of coverage. Let me see how much it was.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm yeah.
[AGENT][NEUTRAL] OK, so the member had an outpatient maximum of 4000 per year.
[CUSTOMER][NEGATIVE] So it is exhausted and the dollar wise, not a visit wise, right?
[AGENT][POSITIVE] Correct, Dollar Dining.
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know the date?
[AGENT][NEUTRAL] The what? I'm sorry?
[CUSTOMER][NEUTRAL] May I know the date?
[AGENT][NEUTRAL] The denial date is the same as the process date, which is [PII].
[CUSTOMER][NEUTRAL] The claim number.
[AGENT][NEUTRAL] Claim number is 3509875.
[CUSTOMER][NEUTRAL] Give me a minute.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Give me a minute.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you please spell out your name?
[AGENT][NEUTRAL] Sure. That's [PII]. That's initial [PII].
[CUSTOMER][NEUTRAL] Yes, so, uh,
[CUSTOMER][NEUTRAL] Can you please check this number have any other insurances there?
[AGENT][NEUTRAL] You're looking for a different date of service or you're looking for another for the same date of service?
[CUSTOMER][NEUTRAL] No, no, no. Uh, I'm asking for this number only and this date of service.
[CUSTOMER][NEUTRAL] Can you please check this number have any other insurances there? Any right to insurances here?
[AGENT][NEUTRAL] If it's
[AGENT][NEUTRAL] If it's regarding, OK, um, Mr. No, if it's regarding the same date of service, there's no other policies available for this member. If it's a different date of service, we do have a, um, another account that started on [PII], but if it's regarding this claim for this date of service, there's no other policies with us.
[CUSTOMER][NEUTRAL] OK. May I know the call reference number for this information? Before that, uh, can you please send the GDB through a fax?
[AGENT][NEUTRAL] What is the fax number?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Fax number is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] To what attention?
[CUSTOMER][NEUTRAL] You put my name.
[CUSTOMER][NEUTRAL] My name
[AGENT][NEUTRAL] OK, um, I'll have to send this before I let you go. Do you mind holding for me so I can send this fax?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][POSITIVE] Sure, sure. Take your time.
[AGENT][NEUTRAL] OK, thank you, one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me, Mr. [PII]. OK, I went ahead and send that over to you. Should be there in a few minutes. Is there anything else I'm gonna help you with today?
[CUSTOMER][NEUTRAL] Nothing else for this claim, uh, uh, but I have one more claim, but it is not for the same patient and the same provider.
[AGENT][NEUTRAL] I'm sorry, I cannot hear you again.
[CUSTOMER][NEUTRAL] Can you please provide the call?
[CUSTOMER][NEUTRAL] I have one more please.
[AGENT][NEUTRAL] You have one more claim?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, um, you said it's the same member or a different member?
[CUSTOMER][NEUTRAL] Different number.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] May I know the call reference number for this one?
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's date.
[CUSTOMER][NEUTRAL] OK, so.
[AGENT][NEUTRAL] OK. And may I have the next uh patient's policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The next policy number is 785155.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] The patient's name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Uh, we are looking for the date of service.
[CUSTOMER][NEUTRAL] Yes, uh, we are looking for the date of service is [PII] and the charge amount is $1,509 even.
[AGENT][NEUTRAL] OK, [PII] amount $1509.
[CUSTOMER][POSITIVE] Yes, you're right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Bear with me.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Sure
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] All right. uh, let's see, that's not it either. Does it look like we have that claim on file for [PII].
[CUSTOMER][NEUTRAL] You don't have a claim?
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] No claim is not on file. Yes, claim is not on file for that date of service.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Can you please verify the uh claims mailing address previously? Uh, we will do this mailing address, [PII].
[AGENT][NEUTRAL] That is the correct address, but I don't see a claim for that date of service.
[CUSTOMER][NEUTRAL] Actually, we submit through paper, we uh we do not submit electronically.
[CUSTOMER][NEUTRAL] We submitted through paper on uh.
[AGENT][NEUTRAL] I understand.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, I do understand that you send it in, but we have not received that claim. It's not on file.
[CUSTOMER][NEUTRAL] Can you please check any rejection on this claim?
[AGENT][NEUTRAL] Any, I'm sorry, can you repeat?
[CUSTOMER][NEUTRAL] Can you please check the rejection on the state of service? Is there any rejection?
[AGENT][NEUTRAL] Um, Mr. No, I can only check by date of service. I don't have any claims on date of service, [PII] for $1509. It's not on file. We don't have it.
[CUSTOMER][NEUTRAL] On these days.
[CUSTOMER][NEUTRAL] To
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can you please provide the payer ID?
[CUSTOMER][NEUTRAL] Electronic priority.
[AGENT][NEUTRAL] OK, this one needs to be either faxed or mailed because it needs the primary you'll be attached to it. Um, we do have a payer ID, but it's best to fax it or mail it because this is a secondary policy.
[AGENT][NEUTRAL] But the payer ID is 60801.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Can you please provide the number effective date and date?
[AGENT][NEUTRAL] Mhm. Sure.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. Effective date on this policy was January.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And it terminated [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] The effective date is [PII].
[AGENT][NEUTRAL] Termination date [PII].
[CUSTOMER][NEUTRAL] Can you please provide the claims time before I remit?
[AGENT][NEUTRAL] Can I provide, I'm sorry, can you repeat that?
[CUSTOMER][NEUTRAL] Claims timely family limit.
[AGENT][NEGATIVE] We don't have timely filing limits.
[CUSTOMER][NEUTRAL] I guess
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, is there anything else I can help you with today?
[CUSTOMER][POSITIVE] Thank you. Thanks for giving it. Nothing else, nothing else. Thank you.
[AGENT][POSITIVE] You're welcome. Thank you for calling ATM. Have a good day.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye.