AccountId: 011433970860
ContactId: e6f178f5-274a-4286-9da3-802348f0dea1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 353359 ms
Total Talk Time (AGENT): 100454 ms
Total Talk Time (CUSTOMER): 145479 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/e6f178f5-274a-4286-9da3-802348f0dea1_20250311T16:01_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] as well calling from the provider's office for checking on a claim. And is your name in as an H or without an H?
[AGENT][NEUTRAL] I have an H at the end.
[CUSTOMER][NEUTRAL] Yeah, for me as well.
[AGENT][NEUTRAL] All right, sir, I'm happy to check claim status today. What is the patient's policy number, please?
[CUSTOMER][NEUTRAL] It is 0231989, sorry, I'll repeat it. 02319989.
[AGENT][NEUTRAL] Alright, thank you. One moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And do you have a good callback number?
[CUSTOMER][NEUTRAL] Callback number is [PII].
[AGENT][POSITIVE] Thank you so much. What's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is going to be uh [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] All right. And then what is the date of service?
[CUSTOMER][NEUTRAL] Date of service is [PII] [PII] and the total charges on this claim is uh
[CUSTOMER][NEUTRAL] $76,180.74.
[AGENT][POSITIVE] Thank you. One moment, let me take a look.
[AGENT][NEUTRAL] All right, so it looks like we did receive a claim for the state of service on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, the claim was denied that the outpatient benefit max for the calendar year had already been met.
[CUSTOMER][NEUTRAL] OK. And may I know the denial date?
[AGENT][NEUTRAL] Claim was denied on [PII].
[CUSTOMER][NEUTRAL] OK. And also just a moment the
[CUSTOMER][NEUTRAL] Is it uh as per the uh amount, the dollar amount or?
[AGENT][NEUTRAL] Uh, yes, it looks.
[CUSTOMER][NEUTRAL] The number of servers, yeah.
[AGENT][NEUTRAL] No, it looks like the outpatient benefit for the calendar year on the member plan is 2400 and they had exhausted that amount.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 2400. OK. Uh.
[CUSTOMER][NEUTRAL] So, uh, for this member previously, uh, the claims were submitted, uh, which was exhausted. Am I right?
[AGENT][POSITIVE] Mhm, correct.
[CUSTOMER][NEUTRAL] Uh, but actually as per checking for this one, we find only, uh, this, uh, particular date of service for this member. We don't find any other date of service.
[CUSTOMER][NEUTRAL] Uh, could you please provide me the date of service on which uh.
[CUSTOMER][NEUTRAL] The date of service on of the claim which was last paid for this service.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Last day of service was that the benefit amount was covered was on [PII]. That's when the amount was exhausted.
[CUSTOMER][NEUTRAL] OK. And also, is it possible that you could uh provide us the OB of this one of this claim that we are discussing?
[AGENT][NEUTRAL] No, I can give you the denial, but I'm not able to give you an EOB for another provider.
[CUSTOMER][NEUTRAL] No, not for that claim, uh, the claim that got denied as maximum benefit exhausted.
[AGENT][POSITIVE] Yes, I can send you that one. What's a good fax number?
[CUSTOMER][NEUTRAL] Uh, it is [PII], sorry, just a moment. It is [PII]. Attention to my name, [PII].
[AGENT][NEUTRAL] Just to confirm, [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, that's on its way. It should be there in a few moments. Is there anything else I can check on for you today?
[CUSTOMER][NEUTRAL] Uh, no, that's it, uh.
[CUSTOMER][NEUTRAL] And yes, may I have the uh and how long will it take for it to get uh faxed to us?
[AGENT][NEUTRAL] About 5 minutes.
[CUSTOMER][NEUTRAL] OK. And may I have the call reference number for a call?
[AGENT][NEUTRAL] Call reference is my name with my last initial than today's date. My name again is [PII]. Last initial is [PII].
[CUSTOMER][POSITIVE] OK. Thank you very much for helping me with this, and that's it for today and have a great day ahead.
[AGENT][NEUTRAL] You too. Bye bye.
[CUSTOMER][NEUTRAL] Mhm bye.