AccountId: 011433970860
ContactId: 128f5482-5f1f-4e8f-aa00-e73ceb1c3d68
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 296519 ms
Total Talk Time (AGENT): 121643 ms
Total Talk Time (CUSTOMER): 141130 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/128f5482-5f1f-4e8f-aa00-e73ceb1c3d68_20250107T17:25_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, I'm sorry, my phone was breaking up. I didn't hear your name.
[AGENT][NEUTRAL] That's OK. It's [PII]
[CUSTOMER][NEUTRAL] Yeah. Thank you, [PII]. My name is [PII]. I'm calling from Children's Hospital of the King's Daughters. I wanted to check status of a medical claim we submitted.
[AGENT][NEUTRAL] Of course I could check on a claim for you. uh, [PII] first, if you don't mind, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, it's
[AGENT][NEUTRAL] No, it's breaking up. [PII], are you still there?
[CUSTOMER][NEUTRAL] 788
[AGENT][POSITIVE] I'm so sorry it it completely cut out there. Could you repeat that?
[CUSTOMER][NEUTRAL] Oh my gosh, I, my, my phone, I'm sorry. Um, it's my callback is, my callback is [PII].
[AGENT][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Extension [PII].
[AGENT][NEUTRAL] Got it, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, it's D as in David, 40 no wait, I'm sorry, that was the benefits and a card ID. Hold on, let me see. American Public Life is a different ID. Um, OK, I have [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. And uh what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Alright, thank you for verifying that and uh what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Day of service on this was [PII], and total bill was $244.10.
[AGENT][POSITIVE] Got it OK thank you one moment please.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] you.
[AGENT][NEUTRAL] OK, so we did receive this claim [PII] we were unable to pay a benefit as uh the maximum benefit for the outpatient for their um their outpatient benefit maximum had been uh exhausted.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, so no benefit payable outpatient, um, benefit max outpatient, OK, benefits were maxed. OK, and is there, is there like a limit?
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Right. If you'd like, I can, I'm sorry.
[AGENT][POSITIVE] Go ahead I'm so sorry. No, you're OK.
[CUSTOMER][NEUTRAL] I'm so sorry, is there like a limit or uh.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Is there like a limit for their outpatient services yearly that I could put in my notes?
[AGENT][NEUTRAL] Yes, um, so give me just a moment. I'll get that policy pulled up, um, so I can see what that amount is. Give me one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and I'm sorry. Sure, I'm sorry to interrupt you. Were you, so this was received and denied um for Benefit Max, um, is it possible for you to fax me that, um.
[AGENT][NEUTRAL] You're fine.
[AGENT][NEUTRAL] Yes, yes, I was gonna offer to do that. Um, what was that fax number for you while I'm getting that policy pulled up?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, our fax number is 866.
[CUSTOMER][NEUTRAL] 807.
[CUSTOMER][NEUTRAL] 663-0.
[AGENT][NEUTRAL] Got it. OK, and would I just put this to your attention?
[CUSTOMER][NEUTRAL] Um, yeah.
[CUSTOMER][NEUTRAL] Yes, I was just gonna say that. It's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Got it. Alrighty. And so let's see.
[AGENT][NEUTRAL] So the outpatient sickness benefit for this policy, it's a maximum of $75 per visit and then they've got a limit of 5 visits per calendar year per covered person.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Per calendar year per person.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, got it. OK, perfect. And then, um, I know you were gonna fax me that, um, EOB, but is there a claim number that I can note?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Of course. Uh, it is, give me just a moment. That is 350-5784.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect. [PII], thank you so much.
[AGENT][NEUTRAL] Of course, yes, you should get this here in about maybe 10-15 minutes depending on how busy your machine is. Uh, was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Um, just a call reference number for today, or would it just be your name and today's date?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Uh, it'd be my first name, last initial, and today's date. Uh, so my name is spelled [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Perfect on today's date. OK, thank you so much for your help. I appreciate it you have a great day.
[AGENT][POSITIVE] Yes ma'am, of course, yeah, thanks for calling APL you too bye bye.
[CUSTOMER][POSITIVE] Thanks. Bye-bye.