AccountId: 011433970860
ContactId: f6573a3f-f3b5-4b2d-8358-bce82d527426
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 747820 ms
Total Talk Time (AGENT): 165660 ms
Total Talk Time (CUSTOMER): 313939 ms
Interruptions: 18
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/f6573a3f-f3b5-4b2d-8358-bce82d527426_20250311T15:42_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the order's office to check on claim status.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Sure, I can assist you with claims, Mr. [PII]. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] It's [PII] it's direct line. Yeah, it's [PII].
[AGENT][NEUTRAL] [PII]. I'm sorry, I didn't get the last two digits.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 02441375.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The rate is [PII] and the full number is $120 even.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] No, it's [PII], correct?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And for future you can check claim status online through our website at [PII] and that's just optional.
[AGENT][NEUTRAL] Yeah, let me see.
[AGENT][NEUTRAL] OK, let me pull this be one moment.
[CUSTOMER][NEUTRAL] Yeah, that's.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 22.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, so it looks like we uh processed the claim on [PII] and the claim was denied. The reason for this denial is
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] The maximum benefit payable for the date of service has been met.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] no.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 17
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] May I know claim receive date?
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, it was received on [PII].
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK, 17.
[CUSTOMER][NEUTRAL] that.
[CUSTOMER][NEUTRAL] Is any member responsibility for this number?
[AGENT][NEUTRAL] OK, um, if there is a remaining balance, it's gonna be up to the provider's discretion. We don't have any contraction or involvement on the remaining of the claim.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, may I know the maximum if it is reached in terms of dollar or receipt?
[AGENT][NEUTRAL] Alright, so let me check, let me see one moment.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] Yeah, I think.
[AGENT][NEUTRAL] Bear with me just a sec.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so it's a daily benefit of $30 so that is um a daily benefit amount.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] So it's dollar value.
[CUSTOMER][NEUTRAL] OK, how much dollar amount is allowed?
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, it looks like it's $30 per day.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] $30 per day, am I right?
[AGENT][NEUTRAL] OK, I do apologize. It's not gonna be 30, it's gonna be $75 per day, maximum of 6 days per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, how much dollar amount has station meant?
[AGENT][NEUTRAL] For this date of service, he already assessed his benefit. That was $75 per day up to 6 days per year.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm not no no no.
[CUSTOMER][NEUTRAL] OK, may I know the claim number?
[AGENT][NEUTRAL] OK, sure. That is 356-618-3.
[CUSTOMER][NEUTRAL] Then could you please send me a copy of Fibiro fax number.
[AGENT][NEUTRAL] What is the fax number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, to your attention.
[CUSTOMER][NEUTRAL] [PII], OK, before that, yeah, yeah, yeah, before that, may I know the last date?
[AGENT][NEUTRAL] OK, do you mind holding for me while I go ahead.
[CUSTOMER][NEUTRAL] When was the patient last me date?
[CUSTOMER][NEUTRAL] Oh
[AGENT][POSITIVE] The date of the last med is the same day because it's per day. It's a daily benefit.
[CUSTOMER][NEUTRAL] I'm not going to.
[CUSTOMER][NEUTRAL] Same day means [PII].
[AGENT][NEUTRAL] [PII] is the date of service.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. OK, please send the copy of your. Yes.
[AGENT][NEUTRAL] OK, um, let me put you on a brief hold so I can send this out. OK, one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for Mr. [PII]. I went ahead and send that over to you should be there in a few minutes. Is there anything else I'm gonna help you with today?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Another call to this number.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date.
[CUSTOMER][NEUTRAL] What's your name?
[AGENT][NEUTRAL] So that's [PII]. That's initial [PII].
[CUSTOMER][NEUTRAL] That is fine.
[CUSTOMER][NEUTRAL] Yes, so yeah, am I right?
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][POSITIVE] OK, thank you. Have a nice day. Bye.
[AGENT][POSITIVE] You're welcome. You as well, Mr. [PII] and thank you for calling EPL.