AccountId: 011433970860
ContactId: f8c87f9b-9d12-442a-b8f5-1b0b9ceb05cd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 329899 ms
Total Talk Time (AGENT): 95501 ms
Total Talk Time (CUSTOMER): 105272 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/f8c87f9b-9d12-442a-b8f5-1b0b9ceb05cd_20250409T14:14_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII]. I'm calling from the provider's office. I'm checking on claims.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Uh yeah, the callback number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. Do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Uh, yeah. Policy number is.
[CUSTOMER][NEUTRAL] 01868764.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Uh patient name is
[CUSTOMER][NEUTRAL] [PII] and date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the date of service?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] And you have to build them out?
[CUSTOMER][NEUTRAL] 272.
[AGENT][NEUTRAL] OK, looks like it was submitted a few times. Let me see which one.
[AGENT][NEUTRAL] Processed.
[AGENT][NEUTRAL] OK, looks like.
[AGENT][NEUTRAL] It was received 9-18-2024, uh, processed 9-232024, and the outpatient maximum for the year was met.
[CUSTOMER][NEUTRAL] OK, so what is that? Could you just explain to me?
[AGENT][NEUTRAL] There's a certain dollar limit that's payable per year, and that was already met.
[CUSTOMER][NEUTRAL] OK. So may I know that uh dollar amount, the limit of that uh dollar limit?
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] This is not a guarantee of payment, basic outline of the policy.
[AGENT][NEUTRAL] Um, pulling it up.
[AGENT][NEUTRAL] Uh, maximum per year is 2550.
[CUSTOMER][NEUTRAL] 2550. OK. And how much depletion is made?
[AGENT][POSITIVE] By the time we received this claim, they had met all of that.
[CUSTOMER][NEUTRAL] OK. OK. So patient is met. OK.
[CUSTOMER][NEUTRAL] OK, so we can build to the patient.
[AGENT][NEUTRAL] Um, this is a secondary policy, and we don't determine patient responsibility.
[CUSTOMER][NEUTRAL] So this is not a patient responsibility, right?
[AGENT][NEUTRAL] We don't determine patient responsibility. I can't tell you if it's patient responsibility. I can just tell you how the claim processed.
[CUSTOMER][NEUTRAL] OK, so as for you, this, uh, no patient responsibility, right? So we can bill it to the patient.
[AGENT][NEUTRAL] I can't tell you what the patient responsibility is. I can't tell you if if there is one or is not one. I can just tell you this is how the claim processed.
[CUSTOMER][NEUTRAL] Mm mm mm.
[CUSTOMER][NEUTRAL] OK, so you're not
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] OK, but this is as per the patient plan, right? Uh, this is, uh, the limit was, uh, made as for the patient policy, right?
[AGENT][NEUTRAL] The maximum payout was met, so we didn't pay anything on this claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, got it. And after that we again uh submitted the uh this claim actually so on uh March.
[CUSTOMER][NEUTRAL] 13 of 25. So did you, did you receive that one also?
[AGENT][NEGATIVE] Yes, it was denied as a duplicate, and then we received it a 3rd time and that was denied as a duplicate too.
[CUSTOMER][NEUTRAL] OK, so the [PII] was also denied for duplicate. So, OK, so this limit has been already made and you are not sure we can be to the patient or not. OK, I got you. I got your point. So and what about the call reference number?
[AGENT][NEUTRAL] Uh, it's just my name and today's date, [PII], and then first [PII], [PII], and today's date.
[CUSTOMER][NEUTRAL] OK, got it. And uh are you able to provide me the claim number as well?
[AGENT][NEUTRAL] Yes, claim number is 3,508,480.
[CUSTOMER][POSITIVE] OK, got it, thank you so much.
[AGENT][POSITIVE] Thanks for calling AT
[CUSTOMER][POSITIVE] And the card number I already brought with, yeah, got it. Thank you so much.
[AGENT][POSITIVE] OK, thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Yeah.