AccountId: 011433970860
ContactId: dbc85cb5-a312-4856-90d8-b50c0d78b578
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 431429 ms
Total Talk Time (AGENT): 143340 ms
Total Talk Time (CUSTOMER): 130950 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/dbc85cb5-a312-4856-90d8-b50c0d78b578_20250516T13:43_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from provider office. Could you please help me that claim status?
[AGENT][NEUTRAL] Sure, I can verify claim status for you. And your name is again?
[CUSTOMER][NEUTRAL] [PII] And could you spell out your name?
[AGENT][NEUTRAL] Uh, it's [PII], last initial [PII] And Ms. [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] Yes. The policy number is 02120179 M as in Mike L as in Lima 7.
[AGENT][POSITIVE] OK, thank you so much and I apologize, give it to me one more time. I think I'm missing a number.
[CUSTOMER][NEUTRAL] 02120179 M as in Mike L as in Lima 7.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII]. This is a direct line, no extension.
[AGENT][NEUTRAL] OK, thank you. And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Patient's first name is [PII]. Last name is uh [PII]'s date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] Yes, the date of service is [PII]. And the bill amount is, uh, just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 316-875 and 71 cents.
[AGENT][NEUTRAL] And do you have the uh balance after primary?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and the amount is?
[CUSTOMER][NEUTRAL] Uh, no. Could you please
[CUSTOMER][NEUTRAL] Uh, no, could you please help me with that general claim status?
[AGENT][NEUTRAL] OK, let me make sure and see if we received the claim, but this policy is secondary online. Give me one moment.
[CUSTOMER][POSITIVE] Yeah, yes, yes, yes, correct.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Give me one moment.
[AGENT][NEUTRAL] Um let's see.
[AGENT][NEUTRAL] OK, I show the claim had been processed as the um inpatient benefit max for the calendar year has been met.
[CUSTOMER][NEUTRAL] OK. So the claims.
[CUSTOMER][NEUTRAL] Limbrosis
[AGENT][NEUTRAL] Yes, the claim process as the benefit max or the inpatient benefit has maxed for the calendar year.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, ma'am. Can you hear me?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello hello?
[AGENT][NEUTRAL] Yes, ma'am. Can you hear me?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] So the claim was paid or processed?
[AGENT][NEUTRAL] It was processed as the benefit, the inpatient benefit has maxed for the calendar year.
[CUSTOMER][NEUTRAL] Uh, just a moment. My system issues, just a moment.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So the claims didn't process.
[AGENT][NEUTRAL] The claim process as the inpatient benefit has maxed for the calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the, uh, basically this claim was denied, correct?
[AGENT][POSITIVE] Correct, because they already met their benefit max payable for inpatient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK. With the same account number, different account number?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] With the same patient account number, a different account number.
[AGENT][NEGATIVE] I'm not understanding what you're asking.
[AGENT][NEUTRAL] Not, it's not per patient account number, it's per calendar year. They've met their benefit max for the calendar year.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So the uh payment was paid to the insured. Correct?
[AGENT][NEUTRAL] Benefit max for the calendar year. Benefits were paid to the insured since they submit the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. May I have the copy of the UB?
[AGENT][NEUTRAL] Sure. What's your fax number?
[CUSTOMER][NEUTRAL] 833
[CUSTOMER][NEUTRAL] 7703616
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK. So they need the primary UB?
[AGENT][NEUTRAL] No, ma'am. It is processed as benefits paid to the insured and the benefit has maxed for the calendar year.
[CUSTOMER][NEUTRAL] OK. OK. Oh, this is inclusive denial, correct?
[AGENT][NEUTRAL] So, is there anything else, Ms. [PII], I can, yes. Is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Uh, no, thank you so much. Thank you for, uh, sorry. May I know the received date and denial date?
[AGENT][NEUTRAL] Sure, claim received [PII], processed on [PII].
[CUSTOMER][NEUTRAL] [PII]. Correct?
[AGENT][NEUTRAL] No, [PII].
[AGENT][NEUTRAL] is when it was received, processed on [PII].
[CUSTOMER][POSITIVE] Thank you so much. Thank you for assisting and uh claim number and call reference number.
[AGENT][NEUTRAL] Uh, reference number you used my name and today's date. The claim number is 35547887.
[CUSTOMER][POSITIVE] Thank you so much. Thank you for assisting. Have a wonderful day. Bye-bye.
[AGENT][POSITIVE] You're welcome. Thank you for calling APL. Bye.