AccountId: 011433970860
ContactId: 01bf96b7-0f1c-4ab2-b0fa-c52b5d610c99
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 279390 ms
Total Talk Time (AGENT): 60555 ms
Total Talk Time (CUSTOMER): 72031 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/01bf96b7-0f1c-4ab2-b0fa-c52b5d610c99_20250327T13:45_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi [PII]. My name is [PII]. I'm calling from the office and checking claim.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[CUSTOMER][NEUTRAL] Extension is [PII].
[AGENT][POSITIVE] OK, thank you [PII].
[AGENT][NEUTRAL] Do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Uh, yes, the policy number is
[CUSTOMER][NEUTRAL] 02319989.
[AGENT][NEUTRAL] And the patient name and date of birth?
[CUSTOMER][NEUTRAL] Yes, the patient name is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And date of birth, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what was that date of service?
[CUSTOMER][NEUTRAL] Yes, data services 553-2024 for $184 even.
[AGENT][NEUTRAL] OK, let me get that pulled up.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Uh, it looks like we processed that and that was denied the outpatient benefit for the calendar year was met.
[CUSTOMER][NEUTRAL] OK. Uh.
[CUSTOMER][NEUTRAL] OK, and what is the date?
[AGENT][NEUTRAL] Uh, it was received [PII], denied [PII].
[CUSTOMER][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] So denied for outpatient benefits for calendar year is met, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Uh, is it based on number of visits or dollar value?
[AGENT][NEUTRAL] Uh, it was.
[AGENT][NEUTRAL] The dollar value.
[CUSTOMER][NEUTRAL] OK. Uh, how much, what is the dollar value for the, uh, last year?
[AGENT][NEUTRAL] Uh, let me see.
[AGENT][NEUTRAL] Uh, it's 2400.
[CUSTOMER][NEUTRAL] And what is the last date?
[AGENT][NEUTRAL] Uh, all we can share is the claim information with you for this particular claim.
[AGENT][NEUTRAL] So it was met prior to when it was submitted.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So you won't provide the last uh midday service, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So, uh, this will be the patient, this will come under the patient responsibility, correct?
[AGENT][NEUTRAL] Um, we do not determine patient responsibility as this is a supplemental policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And can I get the call reference number?
[AGENT][NEUTRAL] Um, call reference number would be my first name. Last initial it's [PII], and then last initial [PII].
[AGENT][NEUTRAL] Today's date. Is there anything else I can help with today, [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Uh, no, and thank you very much for your time and assistance. Have a great day.
[AGENT][POSITIVE] Thank you for calling APL. Have a great day.