AccountId: 011433970860
ContactId: 01999d89-b9a3-42a2-98c3-efff2aa89b4b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 236520 ms
Total Talk Time (AGENT): 86702 ms
Total Talk Time (CUSTOMER): 116786 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/01999d89-b9a3-42a2-98c3-efff2aa89b4b_20250429T18:31_UTC.wav
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[CUSTOMER][NEUTRAL] We
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider office. Um, regarding this call, I'm looking for claim payment status.
[AGENT][NEUTRAL] OK, yeah, I could check on a claim for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Callback number [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, we have.
[CUSTOMER][NEUTRAL] And policy number.
[CUSTOMER][NEUTRAL] 01845868.
[AGENT][NEUTRAL] OK, and what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Sure, member's name, [PII] and date of service [PII].
[CUSTOMER][NEUTRAL] And the total charge of what is 3,0008.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I'm sorry, uh, [PII], would, um, I need the date of birth, uh, for this member, please.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Date of birth?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, my mother's date of birth, [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that. OK, I have that date of service as [PII]. And what was the uh billed amount, please?
[CUSTOMER][NEUTRAL] Bill amount is 3000.
[CUSTOMER][NEUTRAL] $8 even.
[AGENT][NEUTRAL] 2008. OK, thank you. One moment please.
[AGENT][NEUTRAL] OK, so we did receive this claim, uh, we were unable to pay a benefit as their outpatient benefit for the calendar year had been met.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] So, as per member's plan, the patient benefits are existed for this one?
[AGENT][NEUTRAL] Yes, they had used all of their benefits amounts previous to this claim.
[CUSTOMER][NEUTRAL] Mm, yeah, OK. And for this claim and for the date of service, no payment issued for this member.
[AGENT][NEUTRAL] Right as they had used the all the benefit amount for the calendar year.
[CUSTOMER][NEUTRAL] Hm, yeah, OK.
[CUSTOMER][NEUTRAL] And can you verify the when was the claim received and when was the last process date for this one?
[AGENT][NEUTRAL] Um, yes, give me just a moment. I'll let you know that.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so this claim was received [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And it was processed [PII].
[CUSTOMER][NEUTRAL] Mm yeah, OK. So at the time of date of service, the members reach the maximum benefits, so there is no out of.
[CUSTOMER][NEGATIVE] No benefits.
[AGENT][NEUTRAL] Right, no benefits are payable as they had reached their maximum previous to this claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm, yeah, OK. And can I have the claim number?
[AGENT][NEUTRAL] Yes, it is 35.
[AGENT][NEUTRAL] 30,710
[CUSTOMER][NEUTRAL] 353-071-0.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah, OK, and
[CUSTOMER][NEUTRAL] Can I have your name and call reference number?
[AGENT][NEUTRAL] Sure, reference number would just be my first name, last initial, and today's date. Um so my name is spelled [PII] last initial is [PII] And was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] OK, no, thank you. That's it for today. Thank you and have a nice day. Bye-bye.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Of course, thanks for calling APL. You too. Thank you. Bye-bye.