AccountId: 011433970860
ContactId: d9e54660-4e9e-4676-945c-40470fed9757
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 391220 ms
Total Talk Time (AGENT): 147977 ms
Total Talk Time (CUSTOMER): 108577 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/d9e54660-4e9e-4676-945c-40470fed9757_20250131T14:10_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office to check on the claim status.
[AGENT][NEUTRAL] OK, [PII], you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that and what is your callback number, please?
[CUSTOMER][NEUTRAL] Sure, the callback number is [PII], the direct line.
[AGENT][NEUTRAL] OK, thank you. And how many claims, [PII], do you have to check status on?
[CUSTOMER][NEUTRAL] One
[AGENT][NEUTRAL] OK, yes, ma'am. I can help you. And what is that member's policy number, please?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Member ID is 02479558.
[AGENT][NEUTRAL] One moment please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and any information, [PII] that I do provide for you today will be a verification of benefits and not a guarantee of payment. Also, you will use my name along with today's date if you need a call reference number.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And if we have the
[CUSTOMER][NEUTRAL] Sure. Could you please spell your name?
[AGENT][NEUTRAL] It is, my name is [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] And if we do have the claim on file, [PII], and you need a copy of the explanation of benefits, you may print that from our portal.
[AGENT][NEUTRAL] By going to secured. [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Member name is [PII]. Date of birth is [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And the date of service and total bill amount?
[CUSTOMER][NEUTRAL] Date of service is [PII]. Charge amount is $119 even.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] OK, [PII], so, excuse me, this claim was received.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The received date was 9-12-2024.
[AGENT][NEUTRAL] It was processed and denied on 9-17-2024.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 3505602.
[AGENT][NEGATIVE] And the denial states the maximum benefit for the outpatient sickness writer has been exhausted for the calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the maximum allowed visits per year?
[AGENT][NEUTRAL] The maximum benefit for the outpatient sickness rider has been exhausted for the calendar year.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And could you please verify when did the last visit has been met?
[AGENT][NEUTRAL] It was for a claim received prior to your data service.
[CUSTOMER][NEUTRAL] Prior to our date of service, is it uh [PII]?
[AGENT][NEUTRAL] Or another provider.
[AGENT][NEUTRAL] I can't provide you another provider's details on their claim.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, and could you please fax me a copy of BUV?
[AGENT][NEUTRAL] You may print as I gave you the, I did you get the website that I gave it, gave you to print it from?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, no.
[AGENT][NEUTRAL] I gave you our portal website.
[AGENT][NEUTRAL] At [PII]?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh. The first word is secured.
[AGENT][NEUTRAL] So it is secured. [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And now that you have the claim number, you should be able to print that explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much and thank you for your assistance and have a great day.
[AGENT][POSITIVE] Yes, ma'am. You're very welcome. And is there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] No, thank you so much for your help.
[AGENT][POSITIVE] OK, well, thank you again for calling APL and I hope you have a very nice weekend.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.