AccountId: 011433970860
ContactId: f1723766-5afc-4739-9bb4-a2bd6a015531
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 420309 ms
Total Talk Time (AGENT): 129921 ms
Total Talk Time (CUSTOMER): 129149 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/f1723766-5afc-4739-9bb4-a2bd6a015531_20250502T21:55_UTC.wav
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[AGENT][POSITIVE] Afternoon, thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm just calling from the provider's office to check on the claim status.
[AGENT][POSITIVE] OK, sure, I can assist you with claim status. You're breaking up a little bit. May I have your name again?
[CUSTOMER][NEUTRAL] Sure, it's [PII]. And could you please say your name as well?
[AGENT][NEUTRAL] OK. My name is [PII]. That's [PII].
[CUSTOMER][POSITIVE] So, thank you for that.
[AGENT][NEUTRAL] You're welcome, Mr. [PII], and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, it's [PII], and there's no extension. It's a direct line.
[AGENT][NEUTRAL] OK, may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Sure, it's going to be 02505608.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, name is
[CUSTOMER][NEUTRAL] The last name is gonna be the second, um.
[CUSTOMER][NEUTRAL] Yeah. The last name is [PII] And the first name is [PII]
[AGENT][NEUTRAL] OK, and what's the date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] So, the date is going to be uh [PII] and the total bill charges is
[CUSTOMER][NEUTRAL] $4,389.14.
[AGENT][NEUTRAL] OK, thank you. Let me see if I can find this claim and for future, you can check claim status online through our website at [PII] and that's just optional.
[AGENT][NEUTRAL] And let's see what's.
[AGENT][NEUTRAL] OK, let me pull this up. Give me one moment.
[CUSTOMER][NEUTRAL] What if
[CUSTOMER][POSITIVE] Sure, no worries.
[AGENT][NEUTRAL] Yeah, still waiting on the system.
[CUSTOMER][POSITIVE] Exactly
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] Yeah, I.
[AGENT][NEUTRAL] All right, it looks like we processed the claim on [PII] and the claim was denied. The denial reason is benefit maximum for the date of service has been met.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, that's like you know when it was received?
[AGENT][NEUTRAL] Let me get that. That's not on the UB. One moment.
[CUSTOMER][NEUTRAL] Uh, yeah, so when it and when the process it, dinner for maximum benefit exhaust, right?
[AGENT][NEUTRAL] Yes, and the denial date is the same as the process date [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] [PII]. [PII].
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] [PII] and
[AGENT][NEUTRAL] Mhm. And it was received on the [PII]. I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] Passengers are the same, right?
[CUSTOMER][NEUTRAL] Well, it, it's received on [PII] and the cross the test was uh [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Yeah, thank you for that and the need for maximum benefit cost, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah, it's my business due to dollar value or number of visit.
[AGENT][NEUTRAL] OK, that's gonna be the maximum date of service benefits, so that will be the dollar value.
[CUSTOMER][NEUTRAL] The second. Mm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm just a bit confused. You received on [PII] process on [PII], right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yeah, thank you for the information and the plan for maximum benefit is also due to dollar value.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Just a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is there any other pair over there?
[AGENT][NEUTRAL] I'm sorry, can you repeat?
[CUSTOMER][NEUTRAL] Oh, so, uh, is there any other insurance payer?
[AGENT][NEUTRAL] If there's another insurance for this member?
[CUSTOMER][NEUTRAL] Yeah. Yeah, yeah, that's why I'm asking.
[AGENT][NEUTRAL] Um, not that I can see right now. I mean, it's just our policy that is still active.
[CUSTOMER][NEUTRAL] So there's no other active policy, right? There's no other insurance.
[AGENT][NEUTRAL] None that I can see.
[CUSTOMER][POSITIVE] Yeah, thank you for that information. So, just again.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah, thank you for that. And may I have the account number for this?
[AGENT][NEUTRAL] I'm sorry, did you say the reference number or you said the claim number?
[AGENT][NEUTRAL] What number?
[CUSTOMER][NEUTRAL] Both
[AGENT][NEUTRAL] OK. Um, we don't have reference numbers. You can use my name in today's date. The claim number is 355.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] 4874
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you for that all. Have a great weekend.
[AGENT][NEUTRAL] OK. You as well. Is there anything else I can help you with today, Mr. [PII]?
[CUSTOMER][POSITIVE] Oh, thank you. Thank you for the information, so.
[AGENT][POSITIVE] OK. You're welcome and thank you for calling APO. Have a good afternoon. Bye-bye.
[CUSTOMER][POSITIVE] Yeah you too bye bye.
[AGENT][NEUTRAL] OK.