AccountId: 011433970860
ContactId: 12bdd563-29cb-4c02-8a3d-92809320b31f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 251369 ms
Total Talk Time (AGENT): 117703 ms
Total Talk Time (CUSTOMER): 76762 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/12bdd563-29cb-4c02-8a3d-92809320b31f_20250121T16:22_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hey [PII] my name is [PII]. I'm with Affordable employee benefits and we have a claim on one of our members that I wanted to see how that was processed, how it was calculated.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yeah, let me do my best to help you with that, Ms. [PII], and do you have that um that group number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I do, uh, the group number is 11655.
[AGENT][NEUTRAL] 11655.
[AGENT][POSITIVE] Perfect, hang tight with me.
[AGENT][NEUTRAL] And what was the name of the, the group again?
[CUSTOMER][NEUTRAL] The name of the group is JC Cheek.
[AGENT][POSITIVE] Perfect thank you and [PII], could you verify for me pretty please your email address?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][POSITIVE] Perfect. Thank you. I appreciate that. And let's see, we are looking for a particular claim. Do you have that claim number or the individual's policy number I can help you with?
[CUSTOMER][NEUTRAL] I have his policy number it's 02030126.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That's perfect.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Get that pulled up now.
[AGENT][NEUTRAL] Right, and I do see [PII] here and would you just be able to verify his date of birth for me, pretty please?
[CUSTOMER][NEUTRAL] Uh, his date of birth is [PII].
[AGENT][POSITIVE] Thank you, thank you.
[AGENT][NEUTRAL] All right, [PII].
[AGENT][NEUTRAL] And it was the most recent one I'm assuming um.
[CUSTOMER][NEUTRAL] This is actually it was the data service 8:3024.
[CUSTOMER][NEUTRAL] The total charge was 2,491,850.
[AGENT][NEUTRAL] Do you know what the name of the doctor's office was on that one?
[CUSTOMER][NEUTRAL] It was a Baptist Hospital, Baptist Memorial Hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 8:30
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I think it's this one, but hold on one second. I just have to open it all up and you said the total bill amount was 24,000. Did I get that right?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh huh, mhm, 2,491,850.
[AGENT][POSITIVE] OK, perfect. Let me
[AGENT][POSITIVE] OK, yes, this is the one. OK, perfect. So I do have that claim number right here, um.
[AGENT][NEUTRAL] So.
[AGENT][NEUTRAL] The remark I show on the claim, it looks like it had benefits payable. The benefits payable were 3000.
[AGENT][NEUTRAL] $236.93 and the remark I show on that claim is it says that with the payment of this check the policy maximum for the benefit has been met so it looks like we maxed out the benefit on that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that was that outpatient um combined calendar year benefit.
[CUSTOMER][NEUTRAL] OK, so that was the remainder of the 5000 he had available.
[AGENT][NEUTRAL] Mhm, yeah, and then his benefit um maxed out.
[CUSTOMER][NEUTRAL] OK, alright.
[CUSTOMER][POSITIVE] OK, that's what I need to know thank you so much.
[AGENT][POSITIVE] Hey, it's my pleasure. I'm really glad I could help you, Ms. [PII], and is there anything else I can do to take care of you?
[CUSTOMER][POSITIVE] Mhm thanks.
[CUSTOMER][POSITIVE] No, I'm good thank you so much for your help.
[AGENT][POSITIVE] OK. My pleasure. You have such a wonderful day. Thank you.
[CUSTOMER][NEUTRAL] Mhm bye.
[CUSTOMER][POSITIVE] Thanks bye bye.
[AGENT][NEUTRAL] Goodbye.