AccountId: 011433970860
ContactId: f5cdb161-87d8-4611-a838-8d693942e46e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 565830 ms
Total Talk Time (AGENT): 88433 ms
Total Talk Time (CUSTOMER): 125097 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/f5cdb161-87d8-4611-a838-8d693942e46e_20250527T19:15_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Uh yes, my first name is [PII] and my last name is [PII] calling you from the provider's office looking for claim status.
[AGENT][NEUTRAL] I'm sorry, I can barely hear you. Say again.
[CUSTOMER][NEUTRAL] Uh yes, my first name is [PII] and my last name is [PII] calling you from the provider's office looking for claim status.
[AGENT][NEUTRAL] OK, I can verify claim status for you. And [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] Uh yes, the patient's ID is
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, so the business ID is 02179837.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, the callback number is [PII] and uh uh could you please uh repeat again your name please?
[AGENT][NEUTRAL] Sure. It's [PII], last initial [PII]
[AGENT][NEUTRAL] And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, yes, the patient's, uh, first name is uh [PII], last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, and what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] Net of services 7-182023 total charges.
[CUSTOMER][NEUTRAL] $5,134 even.
[AGENT][NEUTRAL] And the balance after primary?
[CUSTOMER][NEUTRAL] Uh, after primary just
[CUSTOMER][NEUTRAL] After primary $986.36.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And the name of the provider's office?
[CUSTOMER][NEUTRAL] Uh, this is uh Southside Regional Medical Center.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I sure that claim process says that outpatient benefits have maxed for the calendar year.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Maximum benefit routes.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, how many times like can we build in a month or in a year?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] So as you say the maximum benefit rate, uh, how many times can we build in a month or in a year?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] I'm not understanding what you're asking.
[CUSTOMER][NEUTRAL] So, uh, you, uh, as the claim is denied its maximum benefit reach, uh, there must be some limits, uh, how many times can be billed.
[CUSTOMER][NEUTRAL] A yearly or monthly.
[AGENT][NEUTRAL] There's not uh limited as far as the many times they go, but just the amount per year they have on the policy.
[CUSTOMER][NEUTRAL] OK, it is regarding about the amount.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh, how much amount?
[AGENT][NEUTRAL] Uh, the patient had an outpatient benefit max of up to 2500 per calendar year.
[CUSTOMER][NEUTRAL] 2500.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And what is the
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK, what is the time you finding?
[AGENT][NEUTRAL] Uh, to submit an appeal, you have up to 180 days from the time the claim was processed to submit an appeal, and you must submit a letter stating the reason for the appeal.
[CUSTOMER][NEUTRAL] Is it uh from the data service or from the uh process it?
[AGENT][NEUTRAL] From the date on which the claim was processed, you have up to 180 days to submit an appeal.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, OK, so, uh, what is the processing?
[AGENT][NEUTRAL] Uh, claim process on [PII].
[CUSTOMER][NEUTRAL] OK, um, OK, uh, just, just hold on, OK, uh, just, uh, just a few minutes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is there anything else I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Uh, OK, OK, uh, yes, uh, just, just.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Why
[AGENT][NEUTRAL] Mmm. I'm working.
[AGENT][NEUTRAL] Maybe.
[AGENT][NEUTRAL] Do you wanna give us a call back?
[CUSTOMER][NEUTRAL] Uh, OK, I'll just uh go. Yes, yes, yes, yes, I can hear you.
[AGENT][NEUTRAL] Hello.