AccountId: 011433970860
ContactId: 01ac9fac-3a60-42b1-aad7-b70e1f142f40
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 166369 ms
Total Talk Time (AGENT): 46900 ms
Total Talk Time (CUSTOMER): 70509 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/01ac9fac-3a60-42b1-aad7-b70e1f142f40_20250321T18:27_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh yes, hello. I need claim status, please. Actually, I have a status. I have just a question of the denial.
[AGENT][NEUTRAL] OK, um, can I get your name and a good callback number?
[CUSTOMER][NEUTRAL] Uh yes. My name is [PII], and the number is [PII].
[AGENT][NEUTRAL] OK so, do you have the policy?
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes, the policy is 2,440,190.
[AGENT][NEUTRAL] And are you with the provider's office?
[CUSTOMER][NEUTRAL] This is uh for a facility claim. This is from the University of Miami Hospital and clinics.
[AGENT][NEUTRAL] And what was the patient name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And did you get a claim number for that or do you have the date of service?
[CUSTOMER][NEUTRAL] Yes, yeah, I do have the claim number is 3,575,030.
[AGENT][NEUTRAL] OK, um, it looks like I have a denial that the policy maximum.
[AGENT][NEUTRAL] Was met with for the benefit.
[CUSTOMER][NEUTRAL] OK. So the max was met. Is the rest of [PII] patient responsibility?
[AGENT][NEUTRAL] Um, we're just a supplemental plan, so we don't determine patient responsibility. We just can simply tell you what we paid and what the policy has available.
[CUSTOMER][NEUTRAL] Right. OK. Does your plan only pay uh deductible, co-insurance, and co-pay, correct?
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] OK. So, uh, the patient has max, her max for the year. That's what it is?
[AGENT][POSITIVE] That is correct. Uh-huh, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, thank you. Let me see if I have another question.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, thank you, [PII]. Do you give me a reference number for the call?
[AGENT][NEUTRAL] A reference number will just be my first name, [PII], last initial [PII], and today's date.
[CUSTOMER][POSITIVE] OK. Thank you very much. Have a good day.
[AGENT][POSITIVE] OK, [PII], thank you for calling APL. Have a great weekend.
[CUSTOMER][NEUTRAL] OK. You too. Bye-bye.
[AGENT][NEUTRAL] Mhm.