AccountId: 011433970860
ContactId: dbb1f6e8-f52a-4879-ad90-85ff78c47607
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 434010 ms
Total Talk Time (AGENT): 124232 ms
Total Talk Time (CUSTOMER): 129235 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/dbb1f6e8-f52a-4879-ad90-85ff78c47607_20250520T13:52_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[AGENT][POSITIVE] Good morning thank you for calling APL.
[CUSTOMER][NEUTRAL] Uh, hi. Yeah.
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] calling for provider to check on additional information about the claim that has been denied. Please note this call will be monitored and recorded for quality and training purpose. How are you doing today?
[AGENT][NEUTRAL] Uh, fine, and I can verify claim status for you and I apologize, your name is again?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, and [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] Yeah, just a second. I'm providing.
[CUSTOMER][NEUTRAL] So, it is D as in Delta 47690173.
[AGENT][NEUTRAL] Uh, it's not one of our policy numbers. Do you have the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure. Patient's first name is
[CUSTOMER][NEUTRAL] [PII], that is the first name of the member. Last name is [PII]. That is the last name. [PII] is the date of birth.
[AGENT][NEUTRAL] OK, and spell that first name again for me, please.
[CUSTOMER][NEUTRAL] Yeah, definitely. [PII], sorry. After [PII], that is [PII], that is the first name of the member.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Could you please spell your name?
[AGENT][NEUTRAL] Sure, it's [PII], and [PII], what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] Yeah, sure. Date of service that is [PII]. The total charge amount, $331.08.
[AGENT][POSITIVE] OK, thank you one moment.
[AGENT][NEUTRAL] OK, and you're calling from?
[CUSTOMER][NEUTRAL] Provider's office. Provider's office name is Complete Health.
[AGENT][NEUTRAL] What's the name
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Complete Health.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Give me one moment.
[AGENT][NEUTRAL] OK, I show on this claim, uh, we paid $50 which is the max benefit payable for the data service.
[CUSTOMER][NEUTRAL] OK. So the claim is denied for maximum benefits exhausted.
[AGENT][NEUTRAL] The claim paid $50 and with that payment, it matched their benefit for the data service.
[CUSTOMER][NEUTRAL] OK. Could you please provide me the allowed amount?
[AGENT][NEUTRAL] There's not a allowed amount, there's just the max benefit that's payable, which is the $50 that was paid.
[CUSTOMER][NEUTRAL] Is there any
[CUSTOMER][NEUTRAL] Is there any patient responsibility?
[AGENT][NEUTRAL] Uh, we can't give patient uh responsibility. We can only verify how the claim was processed.
[CUSTOMER][NEUTRAL] OK. Is there any in the claim?
[AGENT][NEUTRAL] I'm sorry, say again.
[CUSTOMER][NEUTRAL] Is there any denial on the claim?
[AGENT][NEUTRAL] No, the claim was not denied. The claim paid $50 which is the benefit max for that data service.
[CUSTOMER][NEUTRAL] OK, just a second.
[CUSTOMER][NEUTRAL] So, could you please help me with the claim number?
[AGENT][NEUTRAL] Claim number 357-7994.
[CUSTOMER][NEUTRAL] OK. Could you please help me with the EFT number or check number?
[AGENT][NEUTRAL] Check number 2,033,970.
[CUSTOMER][NEUTRAL] Issue date
[AGENT][NEUTRAL] Like a check was issued on [PII].
[CUSTOMER][NEUTRAL] Of 25
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Could you please send me the UB through fax? Is it possible?
[AGENT][NEUTRAL] Sure. What is your fax number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's [PII]. Attention is patient account number.
[AGENT][NEUTRAL] And what is that patient accounts number?
[CUSTOMER][NEUTRAL] That is [PII] [PII].
[AGENT][NEUTRAL] OK, and you said the fax number is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And attention to the patient account number of 2995423 [PII] Victory 15135. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] No. Could you please help me with call reference number?
[AGENT][NEUTRAL] Uh, if you like, you may use my name at today's date.
[CUSTOMER][POSITIVE] OK. Thank you so much for assisting me. Have a great day.
[AGENT][POSITIVE] You too. Thanks for calling APL. Bye.