AccountId: 011433970860
ContactId: fd63aecc-6e1e-41ab-a855-e5822d9d7e28
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 352029 ms
Total Talk Time (AGENT): 139274 ms
Total Talk Time (CUSTOMER): 124883 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/31/fd63aecc-6e1e-41ab-a855-e5822d9d7e28_20241231T18:24_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII], and I'm calling for HR Vision Service. I verified DOP and this call is made for additional information about the denial. Please note the call will be monitored and recorded for quality and training purposes.
[AGENT][NEUTRAL] OK, Mr. [PII], so you're calling for claim status, correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII]. It's a direct line.
[AGENT][NEUTRAL] And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Sure. That's uh 021-918-997.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Patient name is [PII].
[CUSTOMER][NEUTRAL] Gone [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] The date of services [PII] and the amount is $134.43.
[AGENT][NEUTRAL] I'm sorry, can you repeat that one more time?
[CUSTOMER][NEUTRAL] I'm sorry. It's uh [PII].
[CUSTOMER][NEUTRAL] So, date of birth and the date of service is [PII]. I'm sorry. Yeah, right. [PII]. I'm sorry, I'm sorry.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's OK, [PII], and what's the amount?
[CUSTOMER][NEUTRAL] Uh, it's 134.
[CUSTOMER][NEUTRAL] dollars 43 cents.
[AGENT][NEUTRAL] 43 cents. OK, thank you. One moment, let me see if I can find this claim. And for future, you can check claim status online through our website at [PII] and that's just optional. And let me pull the EOB with me just a minute.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] I'm still waiting on the EOB. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it looks like we processed the claim on [PII] and the claim was denied. The reason for this denial is that the calendar year maximum for outpatient office visit has been exhausted for the year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] So it's uh exceeder.
[AGENT][NEGATIVE] The benefits has been exhausted.
[CUSTOMER][NEUTRAL] Yeah, OK. May I know how, how many units for the?
[AGENT][NEUTRAL] Um, one moment.
[CUSTOMER][NEUTRAL] The service?
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] OK, it looks like there's an office visit, maximum $75 per visit, maximum of 6 visits per year.
[CUSTOMER][NEUTRAL] Uh, maximum 6.
[AGENT][NEUTRAL] $75.75 dollars per visit, maximum of 6 visits per year.
[CUSTOMER][NEUTRAL] 6 is it?
[CUSTOMER][NEUTRAL] OK, thank you so much, uh, for the information. One moment. Uh, may I know when was the last services render?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We cannot release that information. I can only give you information pertaining your claim and based on your claim, it was denied due to that reason. Mhm.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, upon checking here, uh,
[CUSTOMER][NEUTRAL] Um, for this one, for code which is 99213, the service has been done for [PII] it's only to visit.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] That's for any provider, not, not just one provider. That's for any provider during the year.
[CUSTOMER][NEUTRAL] I'm sorry, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yeah, OK. Thank you so much. Uh, let me verify the correct mailing address. Let me go.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You need the mailing address which is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Uh, so [PII].
[AGENT][NEUTRAL] Mhm. [PII].
[CUSTOMER][NEUTRAL] 0, right?
[CUSTOMER][POSITIVE] Yeah, OK, thank you so much. May I know the family filing number?
[AGENT][NEGATIVE] We don't have timely filing limits.
[CUSTOMER][NEUTRAL] Yeah, OK. Could you spell your name?
[AGENT][NEUTRAL] Sure, my name is [PII] [PII].
[CUSTOMER][POSITIVE] Yeah, thank you so much for, uh, could you help me with the card reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][POSITIVE] Yeah, thank, yeah, thank you so much for, uh, thank you for resting have a great day and a happy New Year. Enjoy the day.
[AGENT][POSITIVE] You're welcome. You as well. Thank you for calling APM. You're welcome. Bye bye.
[CUSTOMER][POSITIVE] Thank you, bye.