AccountId: 011433970860
ContactId: cd1dece3-62d6-439e-863e-f6e432066722
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1216939 ms
Total Talk Time (AGENT): 232579 ms
Total Talk Time (CUSTOMER): 310510 ms
Interruptions: 8
Overall Sentiment: AGENT=0.4, CUSTOMER=-1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/18/cd1dece3-62d6-439e-863e-f6e432066722_20250418T20:38_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling for the provider to check on a claim status. Please be informed that this call is being recorded and monitored for quality and training purposes. So, may I know how can I help you with the patient's information or the provider's information?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me have a callback number just in case we get disconnected, Mr. [PII].
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. No extension it's a direct line.
[AGENT][NEUTRAL] OK. And what's the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] I'm calling from Midlands Orthopedics and Neurosurgery.
[AGENT][NEUTRAL] OK. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Sure, the patient's policy number is 01673475.
[AGENT][NEUTRAL] Thank you. One moment, let me see if I can find this information.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Uh, the name of the member is, uh, the first name of the member is [PII] and the last name is [PII], and date of birth will be [PII].
[AGENT][NEUTRAL] OK, and what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] The date of service will be [PII] and amount will be just a moment. Let's amount, OK. The amount will be $264 even.
[AGENT][NEUTRAL] 264. That was [PII] [PII], correct?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Right. Um, do you mind holding for me while I get this information for you?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] 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.
[AGENT][NEUTRAL] Thank you for holding and being patient for Mr. [PII]. OK, it looks like um this claim was processed and denied on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And it looks like all benefits were applied towards the calendar year deductible of the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, so could you please tell me when was the claim received?
[AGENT][NEUTRAL] Um, yeah, let me pull that one up. Let's see.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, that's 809.
[AGENT][NEUTRAL] OK, it was received on [PII].
[CUSTOMER][NEUTRAL] OK, so the claim was processed towards the deductible.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so could you please tell me, uh, how much is the annual deductible amount?
[AGENT][NEUTRAL] Oh, sure. Let me get that benefit information pulled up.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Calendar year deductible is 2000.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And how much amount was processed towards deductible?
[AGENT][NEUTRAL] Um, it looks like we applied, um, let's see.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] $128.20.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] $128.20. OK, just a moment.
[AGENT][POSITIVE] Mhm. Correct.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK. And could you please tell me how much patient made the deductible?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right, uh, let's see. So far,
[AGENT][NEUTRAL] Bear with me.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, so as of today for [PII].
[AGENT][NEUTRAL] Um, she has med or he has med. Um, let's see.
[AGENT][NEUTRAL] Mm, it looks like he already met all his deductible. Let me double check.
[AGENT][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] 1517.
[AGENT][NEUTRAL] 6 $1,863.02 so far.
[CUSTOMER][NEUTRAL] 1,862 cents.
[AGENT][NEUTRAL] $1,863.02.
[CUSTOMER][NEUTRAL] And 2 cents. OK. So, uh, so the deductible process in network deductible or out of network deductible?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] This one, it doesn't have any network, so it's just gonna be for outpatient deductible. The outpatient deductible is 2000 and it was, um, that is the amount that he has met so far.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] So it was an out network.
[AGENT][NEUTRAL] We don't have networks. We're not the primary. This is the secondary policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it's not based on network it's it's based on the benefit of the policy, so for the outpatient.
[CUSTOMER][NEUTRAL] So, so it is an outpatient and outpatient deductable, am I right? OK.
[AGENT][POSITIVE] Correct, yes. Mhm.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And could you please tell me to which address the UOB was mailed to?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Uh, it was sent to, let's see, for this one.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I do know what
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK, so it was sent to.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, I mean, but yeah, um.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Could you please repeat the whole address one second again from the [PII]?
[AGENT][NEUTRAL] PO Box 848539
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK and.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Could you please verify me the patient's account number?
[AGENT][NEUTRAL] Um, yes, let me pull that.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] It's 1206291 V as in Victor 5499.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] And could you please help me with the claim number?
[AGENT][NEUTRAL] That is 356-580-9.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] 356-580-9.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is denied you will be required by submitting a uh claim or appeal?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Well that I that I.
[CUSTOMER][NEUTRAL] Uh, could you please help me, OK, could you please send me a copy of EOB?
[AGENT][NEUTRAL] And what is the fax number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 825.
[CUSTOMER][NEUTRAL] [PII] in attention to the patient's account number.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right. um, do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. And how much time will it take to receive the UB?
[AGENT][NEUTRAL] If I send it right now in a few minutes?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yeah
[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. OK, I went ahead and send that over to you, Mr. [PII]. Is there anything else I'm gonna help you with today?
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, the call reference number.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date.
[CUSTOMER][NEUTRAL] And could you please tell me your name once again?
[AGENT][NEUTRAL] Sure. My name is [PII]. That's [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Uh, so.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, thank you sir for your assistance and have a great day and have a great weekend.
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] You as well. Have a good weekend. Thank you for calling APL. Bye-bye, Mr. [PII].
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] this