AccountId: 011433970860
ContactId: d06bbe5f-0ef8-4e96-b77f-b82574316284
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 478959 ms
Total Talk Time (AGENT): 114367 ms
Total Talk Time (CUSTOMER): 119531 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/d06bbe5f-0ef8-4e96-b77f-b82574316284_20250228T20:38_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Hey, good to hear that query. My name is [PII] calling from provider's office checking on claim status and how are you doing today?
[AGENT][POSITIVE] I'm doing good [PII] how are you doing?
[CUSTOMER][POSITIVE] Doing well, thank you for asking. Could you please spell your name? OK. Mhm.
[AGENT][POSITIVE] Awesome.
[AGENT][NEUTRAL] Yes, it's [PII]
[CUSTOMER][POSITIVE] [PII], yes.
[AGENT][NEUTRAL] OK, thank you [PII]. I can help you with claim status can you please give me your call back number?
[CUSTOMER][NEUTRAL] Which is [PII].
[AGENT][NEUTRAL] Thank you. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yeah, patient's name [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] With with number with date of birth [PII] and member ID number 24.
[CUSTOMER][NEUTRAL] Sorry, 02493395 M as in Mary, L as in Lima, followed by 8.
[AGENT][NEUTRAL] OK, thank you. Let me look up that policy number real quick.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, and then what is the date of service for [PII]?
[CUSTOMER][NEUTRAL] All my data services are [PII] for $237 even.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary insurance pay their part?
[CUSTOMER][NEUTRAL] $55.
[AGENT][NEUTRAL] OK, and what is the name of the facility you're calling from, [PII]?
[CUSTOMER][NEUTRAL] Gastrohealth
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I pull up this claim for you and I'll be right back.
[CUSTOMER][POSITIVE] Thank you. Thank you.
[AGENT][NEUTRAL] You're
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK [PII], this is Tory back with you again. I have the claim number it's 3,551,890.
[AGENT][NEUTRAL] And the claim was denied because the outpatient benefit for the calendar year had been met.
[CUSTOMER][NEUTRAL] OK. Notification benefit for calendar.
[CUSTOMER][NEUTRAL] Yeah, I see.
[CUSTOMER][NEUTRAL] OK, which means the maximum benefits exhausted, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And what is the dollar amount for 2024? Are the maximum units have been exhausted or dollar amount has been existed?
[AGENT][NEUTRAL] This dollar amount had been existed and it was $500.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Per day or per year?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] CEO, OK.
[CUSTOMER][NEUTRAL] OK. Could you please help me out when was the last service made by the patient on?
[AGENT][NEUTRAL] You want to know when the last time the patient's service was paid? Is that what you're asking?
[CUSTOMER][NEUTRAL] Uh, I mean, yes, which means as you stated the maximum dollar amount has been met, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] On which date of service it has been made by the patient.
[AGENT][NEUTRAL] I can't give that information. That's private information.
[CUSTOMER][NEUTRAL] Claim number, please?
[AGENT][NEUTRAL] The claim number is 3,551,890.
[CUSTOMER][NEUTRAL] When did you receive and processed and denied the claim?
[AGENT][NEUTRAL] Uh, we received it on [PII] and processed it on [PII].
[CUSTOMER][NEUTRAL] Call reference number?
[AGENT][NEUTRAL] You can use my name, it's [PII] and today's date.
[CUSTOMER][NEUTRAL] First initial of your last name?
[AGENT][NEUTRAL] A
[CUSTOMER][NEUTRAL] OK. Could you please fax a copy of your bit of my fax number, [PII]? That would be helpful to bill the patient for the remaining balance amount.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Actually, yes, I can. What is your fax number, sir?
[CUSTOMER][POSITIVE] Uh thank you for that, [PII]. Uh-huh. Yes, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yes, which is 615.
[CUSTOMER][NEUTRAL] 777
[CUSTOMER][NEUTRAL] 353 6
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I get that fax ready for you and I'll be right back.
[CUSTOMER][NEUTRAL] OK, uh huh OK. You are on hold.
[AGENT][POSITIVE] Thank you, sir.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you [PII] for holding for me. I've got that fax on its way to you now.
[CUSTOMER][POSITIVE] Thank you. Have a great day ahead. Bye-bye.
[AGENT][POSITIVE] You too have a good weekend and thanks for calling APL bye bye sir.