AccountId: 011433970860
ContactId: fd4ae459-22a1-4705-a76e-a0df1fe51e19
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 402600 ms
Total Talk Time (AGENT): 194027 ms
Total Talk Time (CUSTOMER): 158547 ms
Interruptions: 4
Overall Sentiment: AGENT=0.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/fd4ae459-22a1-4705-a76e-a0df1fe51e19_20250106T15:06_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII]. I'm calling from provider's office.
[AGENT][NEUTRAL] OK [PII], can I get a good callback number for you?
[CUSTOMER][NEUTRAL] Sure, the callback number is [PII].
[AGENT][NEUTRAL] OK, and what provider office are you calling from?
[CUSTOMER][NEUTRAL] The name of the provider's office is Sheridan ER Physician Services.
[AGENT][NEUTRAL] OK, and what can I help you with today?
[CUSTOMER][NEUTRAL] I needed to check for the claim status.
[AGENT][NEUTRAL] OK, do you have that policy number?
[CUSTOMER][NEUTRAL] Um, yeah. 02013287.
[AGENT][NEUTRAL] OK, what's that policy number?
[AGENT][NEUTRAL] OK, give me just one moment to get that pulled up.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] you
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Can you verify your patient's name and date of birth for me?
[CUSTOMER][NEUTRAL] is that
[CUSTOMER][NEUTRAL] Sure, the patient's name is [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, I do not have that name here. Let me verify that policy. You said 02013287?
[CUSTOMER][NEUTRAL] Oh, I'm so sorry. Uh, just a mistake. I will provide you the correct policy number. It's 02451824.
[AGENT][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] OK, give me just one second, let me get over to that policy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Alright, so I am seeing that patient now can you verify that date of birth for me?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Sure. The date of birth is [PII].
[AGENT][NEUTRAL] Perfect. OK, um, do you have a claim number or um just the date of service?
[CUSTOMER][NEUTRAL] Just the date of service.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what was that? Go ahead.
[CUSTOMER][NEUTRAL] The date of, yeah, it's [PII].
[AGENT][NEUTRAL] OK, and the total charge amount?
[CUSTOMER][NEUTRAL] $1,006 even.
[AGENT][NEUTRAL] OK, give me just one second.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And I
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] The guy was
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So the number is gonna be 18987-054.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I do have that claim on file.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It is claim number 352-516-4.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Um, we received that on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it was processed on [PII].
[CUSTOMER][NEUTRAL] When
[AGENT][NEUTRAL] And this claim was denied because their maximum for the date of service was already met with a previous claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let's see, let me pull up their policy so I can kind of better explain that denial.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so let's see here.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] So, um, for outpatient benefits, this insured has a per calendar day maximum of $500 and that maximum was met with a previous claim that was submitted.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] OK. Uh, can I get the previous claim, like details of the claim number that was been met?
[AGENT][NEUTRAL] Um, let me see. No, because it's not your physician, um, I'm unable to provide that information. Um, I will let you know that it looks like it was probably the facility for, um, the same ER visit. So where we received your physician's bill, um, we were also received the facility bill.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK. Can't you just uh provide me the claim number just for documentation?
[AGENT][NEUTRAL] No, I cannot provide you with that information. I'm sorry.
[CUSTOMER][NEUTRAL] OK. OK. As I said, it's been met for the doors. So how would I proceed for this claim or the denial?
[AGENT][NEUTRAL] I'm sorry, how would you what?
[CUSTOMER][NEUTRAL] How would I proceed for this denial?
[AGENT][NEUTRAL] Um, so any remaining balances that are left after our claim has been processed, um, how those are handled are between, um, the insured or the patient and the billing provider, um, that concludes our participation with the claim this claim has been denied due to Max being met and so there's we're not going to um.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Leave any patient responsibility, that's not how our policies work. So how that balance is handled is completely up to your provider.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] OK, no problem.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, uh, can I get the caller reference number? That's all like, mhm, sure.
[AGENT][NEUTRAL] Sure it's just gonna be.
[AGENT][NEUTRAL] OK, it's just my name, so that's [PII] last initial [PII] with today's date. Is there anything else I can do for you today, [PII]?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] No, nothing. Thank you so much.
[AGENT][POSITIVE] You're so welcome. I hope you have a great day and thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you. Bye bye.
[AGENT][NEUTRAL] Mhm bye bye.