AccountId: 011433970860
ContactId: fa0790dc-49cd-4448-8634-55011712aa05
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 296339 ms
Total Talk Time (AGENT): 84511 ms
Total Talk Time (CUSTOMER): 85265 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/fa0790dc-49cd-4448-8634-55011712aa05_20250514T12:53_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from provider's office to check on the claim status.
[AGENT][POSITIVE] All right, [PII], I'm happy to help check on a claim status. What is the patient policy number?
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Yeah. It's 02570582.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure. Patient name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you and the date of service?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] service on.
[CUSTOMER][NEUTRAL] [PII]. And the total bill amount, $1,365 even. It's $1365.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Alright, thank you for your patience on that. So it looks like we did receive a claim for this state of service claim is received on [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim was denied [PII]. The inpatient benefit max for the calendar year has already been met.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEGATIVE] The inpatient benefit max has already been met. There was nothing payable.
[CUSTOMER][NEUTRAL] Many have been.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] Maybe I uh dollar amount for that?
[AGENT][NEUTRAL] Uh, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The inpatient outpatient benefit max is a combined amount for the year of $3000 that looks like.
[CUSTOMER][NEUTRAL] $3000. It's a combined amount?
[AGENT][NEUTRAL] For inpatient and outpatient, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh may I know the claim number?
[AGENT][NEUTRAL] Uh, the claim number for that is going to be 358-086-1.
[CUSTOMER][NEUTRAL] OK. And can you uh send the denied UB to fax?
[AGENT][NEUTRAL] Uh, yes, what's the fax number?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. And you can uh attention my name as [PII]
[AGENT][NEUTRAL] OK. So give me about 5 minutes and that'll be on its way. Is there anything else that I can check for you today?
[CUSTOMER][POSITIVE] Yeah, that's it, ma'am. Thank you so much. And may I know your name and the call reference number?
[AGENT][NEUTRAL] Absolutely. Call references my name with my last initial, then today's date. My name again is [PII], that's [PII] Last initial is [PII], and then today's date.
[CUSTOMER][POSITIVE] OK. Thank you so much for the information and have a great day.
[AGENT][NEUTRAL] You as well. Bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.