AccountId: 011433970860
ContactId: f84fe7ba-830c-4ce5-8e84-4402219aa173
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 471559 ms
Total Talk Time (AGENT): 114288 ms
Total Talk Time (CUSTOMER): 151716 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/f84fe7ba-830c-4ce5-8e84-4402219aa173_20250121T21:47_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from Express urgent Care. I'm here to check your claim status. Would you able to assist me today?
[AGENT][POSITIVE] All right, [PII], I'm happy to check a claim status for you today. May I have the policy number?
[CUSTOMER][NEUTRAL] Yeah, please make note of it. It's
[CUSTOMER][NEUTRAL] Just give me a moment. I'll
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Ah
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] It's 1905619.
[AGENT][NEUTRAL] All right, let me pull that up here. One moment.
[AGENT][NEUTRAL] What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, patient name is [PII], and the date of birth is [PII].
[AGENT][POSITIVE] Thank you for that and date of service?
[CUSTOMER][NEUTRAL] And this data service is on.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Fill them out.
[CUSTOMER][NEUTRAL] It's $629 even.
[AGENT][NEUTRAL] 600 and how much?
[CUSTOMER][NEUTRAL] $29.
[AGENT][NEUTRAL] 629. All right, thank you. One moment please.
[CUSTOMER][NEUTRAL] that.
[AGENT][NEUTRAL] So it looks like we did receive this claim on [PII].
[AGENT][NEUTRAL] Claim was denied.
[CUSTOMER][NEUTRAL] Is this [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Yeah, and process done?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim was denied that the outpatient benefit max has already been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, can I know the, uh, allowed amount for, um, like, uh, how, how are you stating that the outpatient visit has been maxed either by visiting or uh it's an annual payment with like.
[AGENT][NEGATIVE] Uh, the outpatient benefit max for the calendar year on this plan is 4500 and that had been already paid out. There was nothing additional payable.
[CUSTOMER][NEUTRAL] May I know when the patient has lastly visited the provider's office?
[AGENT][NEUTRAL] Um, are you just looking for the last date of service where the patient had a claim paid?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, yeah, yeah, exactly.
[AGENT][NEUTRAL] Well, the last claim on file that shows was paid was for a date of service of [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, the claim has denied and moved to patient responsibility. Am I correct?
[AGENT][NEUTRAL] We're not able to advise on patient responsibility that would be up to the facility or provider.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Just give me a moment.
[CUSTOMER][NEUTRAL] Uh, thank you for your patience, [PII]. Uh, can I get the claim number on the date of service of [PII]?
[AGENT][NEUTRAL] 351451-3
[CUSTOMER][NEUTRAL] Uh, sorry, sorry. Could you spell me uh slow 351.
[AGENT][NEUTRAL] 3351.
[AGENT][NEUTRAL] 451 3.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 4513.
[CUSTOMER][NEUTRAL] Uh, thank you, sir. And can I get a claim number for the current data service that is on [PII]?
[AGENT][NEUTRAL] 354.
[AGENT][NEUTRAL] 11
[CUSTOMER][NEUTRAL] 354
[CUSTOMER][NEUTRAL] 11
[AGENT][NEUTRAL] 82.
[CUSTOMER][NEUTRAL] 82. And could you please provide me your call reference number?
[AGENT][NEUTRAL] Call reference is my name with my last initial in today's date. My name again is [PII], that's [PII] Last initial to my name is [PII].
[CUSTOMER][NEUTRAL] [PII] and followed by today's date, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Just give me a moment. I'll keep it posted on my notes.
[CUSTOMER][NEUTRAL] OK. Uh, and sir, sir, can you give me the, uh, timely filing limit for the claim and your mailing address?
[AGENT][NEGATIVE] No timely filing.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No time paying limits, right?
[AGENT][NEUTRAL] Claims
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And the mailing address, please?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] 2
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 2
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] In [PII], [PII].
[CUSTOMER][NEUTRAL] [PII]. OK. ZIP code?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK. That's it for the day, [PII]. Thank you for asking, [PII]. Have a wonderful day.
[AGENT][POSITIVE] You too, [PII]. Take care. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.