AccountId: 011433970860
ContactId: 1452cc2c-88cb-4a66-9d91-9077eb33108a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 495179 ms
Total Talk Time (AGENT): 95776 ms
Total Talk Time (CUSTOMER): 137184 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/1452cc2c-88cb-4a66-9d91-9077eb33108a_20250620T16:07_UTC.wav
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[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, hi, [PII]. This is [PII] calling from University of Miami to check on a claim status.
[CUSTOMER][NEUTRAL] How are you doing today, [PII]?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][POSITIVE] Yeah, good to hear that. Thank you for asking. Yeah, doing good as well, just waiting for a week.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. It will be [PII].
[CUSTOMER][NEUTRAL] [PII] with an extension of [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Yeah, just a moment.
[CUSTOMER][NEUTRAL] Just one thing you know.
[CUSTOMER][NEUTRAL] Can I get your last name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mm OK.
[CUSTOMER][NEUTRAL] OK, perfect. Can I go with the member ID number?
[AGENT][NEUTRAL] OK, and what is the policy number?
[CUSTOMER][POSITIVE] Thank you for that. Yup, it will be 02570582.
[AGENT][NEUTRAL] Yeah, one moment.
[CUSTOMER][POSITIVE] Yeah, sure, take your time.
[AGENT][NEUTRAL] Can you verify the patient's name and their date of birth for me, please?
[CUSTOMER][NEUTRAL] Yeah, definitely it will be [PII]. Date of birth will be [PII].
[AGENT][NEUTRAL] Do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] I think I do have a claim number. Can I go on?
[AGENT][NEUTRAL] 01 moment.
[CUSTOMER][NEUTRAL] Yeah, sure you.
[AGENT][NEUTRAL] Alright, what is the claim number?
[CUSTOMER][NEUTRAL] Yeah, just a moment, let me get that for you.
[CUSTOMER][NEGATIVE] Fucking.
[CUSTOMER][NEUTRAL] Just a moment I'm getting it.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sorry for the delay in delay ma'am.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] Yeah, I got the claim number.
[CUSTOMER][NEUTRAL] It will be 358-086-1.
[AGENT][NEUTRAL] Alright, it looks like we processed that claim on March I'm sorry, we received that claim on [PII].
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it looks like.
[AGENT][NEUTRAL] That claim was denied because the inpatient benefit for that calendar year has been met.
[CUSTOMER][NEUTRAL] You're saying that uh maximum benefit met right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK and uh may I know the.
[CUSTOMER][POSITIVE] Maximum benefit a month as well.
[AGENT][NEUTRAL] You want the maximum benefit? Give me one moment.
[CUSTOMER][NEUTRAL] Yeah sure.
[AGENT][NEUTRAL] It looks like they have a com um and this is just a verification of benefits, not a guarantee of payment, but they have a combined inpatient and outpatient maximum of $3000 per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, perfect. Could you please send me a copy of UB through fax engineer.
[AGENT][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] And what is a good fax number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It'll be [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][POSITIVE] Yeah, so thank you.
[AGENT][NEUTRAL] And to confirm, I have fax number [PII], correct?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Yeah, that's right.
[CUSTOMER][NEUTRAL] [PII], just to confirm it's [PII] with that attention my name [PII].
[CUSTOMER][NEUTRAL] And I still have just one more claim left. Could you please help me with that engineer?
[AGENT][NEUTRAL] OK, I just sent that fax over. Is it for the same patient or a different patient?
[CUSTOMER][NEUTRAL] I think it's for a different one.
[AGENT][NEUTRAL] OK, give me just one moment to um.
[AGENT][NEUTRAL] Finish this patient's notes out.
[CUSTOMER][POSITIVE] Yeah, definitely take your time.
[CUSTOMER][POSITIVE] Yep, yep, yep take it there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, I think, uh, sorry, and I think that's all the claim I have, I guess. Can I get the call reference number for this one?
[AGENT][NEUTRAL] Oh, sure, it is um we don't have a call reference number so you can use my name and last initial in today's date. So [PII] in today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you, [PII]. It's been a pleasure talking with you. I hope you have a great day and happy weekend.
[AGENT][POSITIVE] Great, thank you for calling APL have a great weekend.
[CUSTOMER][NEUTRAL] Yeah bye bye.
[AGENT][NEUTRAL] Written by.