AccountId: 011433970860
ContactId: e49028c0-1b4c-4046-94f1-8f4655f3709e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 239520 ms
Total Talk Time (AGENT): 107679 ms
Total Talk Time (CUSTOMER): 109673 ms
Interruptions: 1
Overall Sentiment: AGENT=1.7, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/e49028c0-1b4c-4046-94f1-8f4655f3709e_20250319T18:15_UTC.wav
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[AGENT][POSITIVE] Good afternoon, thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] calling from the provider's office to check on a claim status for a member.
[AGENT][POSITIVE] [PII], it would be my pleasure to assist you with that claim status. What is a good callback number, please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure, my callback number is [PII] and it's a direct line.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Sure. It is uh 02, sorry, 02100189 M like Mary, L like Lima number 8.
[AGENT][NEUTRAL] Thank you, [PII] and the patient's name and date of birth, please, sir?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Patient's name is [PII]. and the date of birth is [PII].
[AGENT][POSITIVE] Alright, thank you, and it would be my pleasure to assist you with that claim status. [PII], do you have the claim number or date of service?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um, I do not have the claim number, but the date of service is, uh, September 23rd of 2024.
[AGENT][NEUTRAL] And what is the bill amount, please?
[CUSTOMER][NEUTRAL] Built amount is $991 even.
[AGENT][POSITIVE] Thank you. And the facility name, please?
[CUSTOMER][NEUTRAL] It is elite imaging also called as a human.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] I'm just checking on that for you. Now, it looks like we've received.
[AGENT][NEUTRAL] That claim
[AGENT][NEUTRAL] For $991.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That was received on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And this claim was denied as the outpatient benefit for the calendar year has been met.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, sorry, you said the outpatient visit?
[AGENT][NEUTRAL] Outpatient benefits.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] For the calendar year has been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And uh may I know what was the uh maximum limit?
[AGENT][NEUTRAL] Yes, so that would.
[CUSTOMER][NEUTRAL] For the outpatient benefits.
[AGENT][NEUTRAL] Sure, that is a $1 amount and that outpatient benefit is $2500 per calendar year.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] And that is a verification of coverage, not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK. Thank you so much for that information. So, um, I just wanted to make sure one more thing, like if the uh benefits are maxed out, um, the bill amount would be the patient's responsibility, right?
[AGENT][NEUTRAL] And we're not major medical. We don't determine patient responsibility, that would be determined by the provider.
[CUSTOMER][NEUTRAL] uh uh.
[CUSTOMER][POSITIVE] Mm, OK, got it. Thank you so much for that information, [PII]. And uh, yeah, that was all the information I needed for today. So lastly, can you help me with the call reference number for this call?
[AGENT][NEUTRAL] I can and also [PII], before I give you that call reference, do you need that claim number?
[CUSTOMER][POSITIVE] Oh yeah. Thank you so much for that.
[AGENT][NEUTRAL] You're welcome. The claim number is 351.
[AGENT][NEUTRAL] 831 9
[CUSTOMER][POSITIVE] OK. OK, thank you so much.
[AGENT][POSITIVE] My pleasure. And the call reference number is my name and today's date, and I spell my name [PII].
[CUSTOMER][POSITIVE] OK. OK, then, uh, [PII], thank you so much for your assistance and have a great day. Take care. Bye-bye.
[AGENT][POSITIVE] Oh, and [PII], thank you for calling APL. I hope you have a wonderful day as well. Take care.
[CUSTOMER][NEUTRAL] Mhm. You too. Bye.
[AGENT][NEUTRAL] Bye bye.