AccountId: 011433970860
ContactId: e8341c62-ec54-4539-af8e-dd0b54c9d412
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 390230 ms
Total Talk Time (AGENT): 121012 ms
Total Talk Time (CUSTOMER): 158502 ms
Interruptions: 5
Overall Sentiment: AGENT=1.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/e8341c62-ec54-4539-af8e-dd0b54c9d412_20250110T15:01_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, good morning. This is [PII]. You're calling from provider's office, and I'm looking for clearing status.
[AGENT][POSITIVE] OK, yeah, I'd love to help you with claim status today and do you mind if I get a good callback number from you?
[CUSTOMER][NEUTRAL] OK, yeah, that's gonna be a same status today and you.
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] It's [PII], and this is the direct line?
[AGENT][POSITIVE] Perfect. And what's that member's policy number today?
[CUSTOMER][POSITIVE] Perfect. And what's that policy number today?
[CUSTOMER][NEUTRAL] The policy number is 2448572.
[AGENT][POSITIVE] Wonderful. Give me a moment to get that pulled up.
[CUSTOMER][POSITIVE] Wonderful, give me a moment to get that pulled up.
[AGENT][NEUTRAL] Perfect. And your patient's first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] Perfect and your patients first and last name and date of birth please?
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] The member's name is [PII].
[CUSTOMER][NEUTRAL] Yes, sir. And the date of birth is [PII].
[AGENT][POSITIVE] Perfect, thank you so much. And what is the date of service on the claim we're looking for for her?
[CUSTOMER][POSITIVE] Perfect thank you so much. And what is the date of service on the team we're in for for her?
[CUSTOMER][NEUTRAL] I'm looking for the general claim status for the date of service [PII].
[AGENT][NEUTRAL] And the bill amount?
[CUSTOMER][NEUTRAL] And the build out.
[CUSTOMER][NEUTRAL] 1200. OK. So you're checking the claim has been split into two amounts, that is $1,295 and $600.
[AGENT][NEUTRAL] OK, so there should be 2 different claims, 2 different amounts. Is that correct?
[CUSTOMER][NEUTRAL] OK, so there should be 2 different 2 different amounts, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Conti.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] Very
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] All right, I believe I was able to locate both those claims for you. Give me just a moment to get them pulled up.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] A laptop.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Thank you, sir.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] And what was the name of the facility on file for this?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's not Hematology oncology Associate.
[AGENT][POSITIVE] Thank you so much. Alright, so I'm gonna start with the one with the charge of 1,295.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] It looks like we received your claim on [PII].
[CUSTOMER][NEUTRAL] It looks like.
[CUSTOMER][NEUTRAL] I
[AGENT][POSITIVE] It looks like, let me find when we processed it. I'm so sorry.
[AGENT][NEUTRAL] It looks like we processed it on.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII]? No, not December. I'm so sorry, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And your claim number is 3512189.
[AGENT][NEUTRAL] I show that the claim was denied, stating that the calendar year maximum for outpatient office visits due to sickness and or accident has been met for this calendar year.
[CUSTOMER][NEUTRAL] 9
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Could you please repeat the denial, denial reason?
[AGENT][NEUTRAL] The calendar year maximum.
[CUSTOMER][NEUTRAL] Calendar year maximum.
[AGENT][NEUTRAL] For outpatient.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Office visits.
[AGENT][NEUTRAL] Due to sickness.
[AGENT][NEUTRAL] And or accident.
[CUSTOMER][NEUTRAL] Due to?
[AGENT][NEUTRAL] I'm sorry, sickness and or accident.
[CUSTOMER][POSITIVE] I'm sorry
[AGENT][NEUTRAL] Has been met for this calendar year.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Has been met. OK, just a moment.
[CUSTOMER][NEUTRAL] OK, OK, is it maximum, just a moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Maximum for outpatient office visit.
[CUSTOMER][NEUTRAL] Did you end your accident has been met. Am I right?
[AGENT][NEUTRAL] Due to sickness and or accident.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Sickness, OK.
[CUSTOMER][NEUTRAL] Due to sickness and your accident has been met. OK, just a moment.
[CUSTOMER][POSITIVE] Thank you so much. Could you please provide me the reference number for this?
[AGENT][NEUTRAL] Yes, um, well, we don't have reference number, so the whole call will have the same one and it's gonna be my name, [PII], first initial last name, [PII], and today's date.
[CUSTOMER][NEUTRAL] Yes, um
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] First initial last name
[CUSTOMER][POSITIVE] OK, [PII], thank you so much for assisting me. Have a good day.
[AGENT][NEUTRAL] Did you want claim status for the other claim and like the number on that and everything?
[CUSTOMER][NEUTRAL] other
[CUSTOMER][NEUTRAL] And like the number on that
[CUSTOMER][NEUTRAL] No, this is the only claim which I was having with me.
[AGENT][POSITIVE] Oh, OK, perfect. Awesome. I'm so glad we could help you out today.
[CUSTOMER][POSITIVE] Oh, OK, perfect.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] My pleasure thank you for calling APL you have a great day.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Bye-bye.