AccountId: 011433970860
ContactId: fc87cf8e-9b0c-4c89-b587-f6524108c0ef
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 409299 ms
Total Talk Time (AGENT): 110783 ms
Total Talk Time (CUSTOMER): 206351 ms
Interruptions: 7
Overall Sentiment: AGENT=-0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/fc87cf8e-9b0c-4c89-b587-f6524108c0ef_20250610T15:17_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, hi, this is [PII] calling from the provider's office to check on a claim status.
[AGENT][NEUTRAL] I'm sure [PII], I can assist you with claim status. Um first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] I'm sure [PII] I can assist you with client status and first could I get a good callback number just in case we're disconnected? Sure, that's [PII] and it's the direct line.
[AGENT][NEUTRAL] OK. Thank you. Now, I need the policy number, please.
[CUSTOMER][NEUTRAL] Thank you now I need the policy number please. It is 02498570.
[AGENT][NEUTRAL] Please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] you verify the patient's name and date of birth. Sure. The patient name is [PII]. Date of birth of [PII].
[AGENT][NEUTRAL] OK. Thank you. Now I need the date of service and bill charges on the claim.
[CUSTOMER][NEUTRAL] Thank you, now I need the date of service and no charges. This is for [PII] and the bill amount is $76 evening.
[AGENT][NEUTRAL] OK, one moment, please.
[CUSTOMER][NEUTRAL] OK, one moment please.
[AGENT][NEUTRAL] OK, and please repeat the bill charges.
[CUSTOMER][NEUTRAL] OK, and please repeat the bill charges. $76 even.
[AGENT][NEUTRAL] OK. Yes, ma'am. We received this claim on [PII].
[CUSTOMER][NEUTRAL] OK, yes, we received this claim on [PII].
[AGENT][NEUTRAL] And the claim processed on [PII].
[CUSTOMER][NEUTRAL] And the claim process on [PII] mhm.
[AGENT][NEUTRAL] The claim number is 358-5204.
[CUSTOMER][NEUTRAL] The claim number is 358-5204.
[AGENT][NEGATIVE] And this claim actually denied because the benefit maximum.
[CUSTOMER][NEGATIVE] And this client actually denied because the benefit maximum um for this occurrence was reached on a previous client.
[AGENT][NEUTRAL] Um, for this occurring was reached on a previous claim.
[CUSTOMER][NEUTRAL] Uh, so, you, uh, could you please confirm, uh, whether the
[CUSTOMER][NEUTRAL] Number of visits or the dollar value has been reached for this claim.
[AGENT][NEUTRAL] Right, the dollar value had been reached for this claim. We cover up to $1000 per occurrence, and the $1000 was met on a previous claim.
[CUSTOMER][NEUTRAL] Right, dollar.
[CUSTOMER][NEUTRAL] We cover up to $1000 per time.
[CUSTOMER][NEUTRAL] The $1000 was met on the previous client.
[CUSTOMER][NEUTRAL] May I, uh, may I know the claim number?
[AGENT][NEUTRAL] Yes, it was me
[CUSTOMER][NEUTRAL] The previous claim number.
[AGENT][NEUTRAL] Yeah, it was met under claim number 3547315.
[CUSTOMER][NEUTRAL] Yes, it was met
[CUSTOMER][NEUTRAL] Yeah, it was met on claim number 3547315. 354-731-5, right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Yes. Uh, thank you so much. Just a moment, I'm checking.
[CUSTOMER][NEUTRAL] So may I know the current to claim family filing limit?
[AGENT][NEUTRAL] Every 90 days we cover up to $1000.
[CUSTOMER][NEUTRAL] Every 90 days we cover up to $1000.
[CUSTOMER][NEUTRAL] Uh-huh. So, um, just for the documentation purpose.
[AGENT][NEUTRAL] Please repeat your question.
[CUSTOMER][NEUTRAL] Please repeat your question. Uh, so just for my documentation purpose, may I know the current claim timely filing limit?
[AGENT][NEGATIVE] There is no timely filing limit.
[CUSTOMER][NEUTRAL] There's no family.
[CUSTOMER][NEUTRAL] OK. Um, so, uh, you mean, uh, so the $1000 has been, um, allowed for this patient benefit as per one year?
[AGENT][NEUTRAL] $1000 per occurrence and every occurrence is every 90 days. We cover up to $1000 for the co-pay, the co-insurance, and the deductible after the primary insurance processes the claim.
[CUSTOMER][NEUTRAL] $1000 per occurrences every 90 days we cover up to $1000 for the co-pay, the co-insurance, and the deductible after the primary insurance processes the claim.
[CUSTOMER][NEUTRAL] So, uh, you provided, uh, the previous claim number on which the um benefits has been, uh, met already. Is this a physician claim or the hospital claim?
[AGENT][NEUTRAL] One moment. Let's see.
[CUSTOMER][NEUTRAL] One ma'am. Sure.
[AGENT][NEUTRAL] Is the hospital client.
[CUSTOMER][NEUTRAL] It's the hospital plan. OK.
[CUSTOMER][NEUTRAL] And uh so is it possible to send a copy of EOB to our fax?
[AGENT][NEUTRAL] Um, yes, to the, for the denied claim that you're calling about. Yes, I can send you that EOB. What's your fax number?
[CUSTOMER][NEUTRAL] Um, yes, to the, for the denied claim that you're calling about, yes, I can send you that ELP. What's your fax number? [PII]. Attention will be my name, [PII].
[AGENT][NEUTRAL] OK, so that's attention, [PII] [PII].
[CUSTOMER][NEUTRAL] OK, so that's attention [PII] now [PII]. Yes, perfect. Uh, and, and, and I'm sorry I just missed your name. Could you please repeat your name for me?
[AGENT][NEUTRAL] Yes, my name is [PII].
[CUSTOMER][NEUTRAL] Yes, my name is Easy. It's spelled [PII].
[CUSTOMER][NEUTRAL] And may I know the call reference number for your conversation?
[AGENT][NEUTRAL] It will be my name and today's date. Um, is there anything else I can assist you with?
[CUSTOMER][POSITIVE] It will be my name in today's date. Um, is there anything else I can assist you with? Um, that's it for the day. Thank you so much, and you may have a wonderful rest of the day. Bye bye.
[AGENT][NEUTRAL] You do the same, [PII], thank you for calling ATL. Mm bye.
[CUSTOMER][POSITIVE] You do the same thank you for calling IT yeah bye.