AccountId: 011433970860
ContactId: ed04b35d-0f4e-402a-97d4-b429d3194136
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 304350 ms
Total Talk Time (AGENT): 109001 ms
Total Talk Time (CUSTOMER): 75980 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/ed04b35d-0f4e-402a-97d4-b429d3194136_20250220T22:26_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]. This is [PII] calling from the provider's office to conducting status.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the claim status, [PII]. May I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yes, it is [PII]. Could you please spell that for me?
[AGENT][NEUTRAL] I'm sorry, hold on one moment. [PII]. What was the last four digits?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, and you asked for my name?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] My name is [PII] The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Yeah, please go ahead.
[AGENT][NEUTRAL] And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, it is 02258551.
[AGENT][NEUTRAL] Thank you. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Just give me one second, I'll check and I'll let you know about it. And I do have, uh, only one.
[AGENT][NEUTRAL] OK, can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII] and the date of birth which is [PII].
[AGENT][NEUTRAL] Thank you. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] [PII] and with the total charge of $297 even.
[AGENT][NEUTRAL] Thank you and all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment while I locate the claim for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] It's Mercy Clinic, Oklahoma.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So shall we receive the claim on [PII]?
[AGENT][NEUTRAL] The claim number is 323.
[AGENT][NEUTRAL] 0257.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim a total of $50.
[AGENT][NEUTRAL] Did you need that check information?
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yes, and uh what are the line items that actually got denied?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][POSITIVE] Yeah, take your time.
[AGENT][NEUTRAL] OK, all lines were denied except for 99213, which the $50 was applied.
[AGENT][NEGATIVE] The other lines were denied us.
[CUSTOMER][NEUTRAL] Mhm. May I know the email address, sir?
[AGENT][NEUTRAL] Oh, I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] May I know the reason for the line items?
[AGENT][NEGATIVE] The other lines were denied because the maximum benefit payable has been met.
[CUSTOMER][NEUTRAL] According to the dollar value or according to the service limit, uh the maximum benefits has been exhausted.
[AGENT][NEUTRAL] The benefit payable, the dollar amount.
[CUSTOMER][NEUTRAL] So the dollar.
[CUSTOMER][NEUTRAL] According to the dollar value, the
[AGENT][POSITIVE] Yes, so let me get the benefits for you. Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah, could you please send that EOP through the fax?
[AGENT][NEUTRAL] What's a good fax number for you?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 440
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So for the benefit, the benefit was uh for the physician office, it's up to $50 for visits per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, help me with the call first number we can wrap up the call.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII]. And was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, that's all. Thank you so much.
[AGENT][POSITIVE] All right. Well, thanks for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Have a great day. Bye.
[AGENT][NEUTRAL] Bye bye.