AccountId: 011433970860
ContactId: 152b137f-73a8-4812-bfec-8091e0f7e271
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 300440 ms
Total Talk Time (AGENT): 69699 ms
Total Talk Time (CUSTOMER): 49733 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/152b137f-73a8-4812-bfec-8091e0f7e271_20250429T17:25_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider office to check on clients. Can I help?
[AGENT][NEUTRAL] Good, um, [PII], do you have a good callback number and I can help you with claim status?
[CUSTOMER][NEUTRAL] [PII]. May I have your name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] [PII], thank you.
[AGENT][NEUTRAL] The patient's policy number?
[CUSTOMER][NEUTRAL] The policy number is
[CUSTOMER][NEUTRAL] 01792571.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] member's name is [PII] and her date of birth is [PII].
[AGENT][NEUTRAL] Yeah, OK, looks like this policy terminated [PII]. Let me pull up a newer policy. Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And you have the date of service and bill charges?
[CUSTOMER][NEUTRAL] The date of service is number [PII] for the the amount of $1680 even.
[AGENT][NEUTRAL] It looks like we received the claim on [PII].
[AGENT][NEUTRAL] Process [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, the maximum amount payable for this occurrence has been met.
[CUSTOMER][NEUTRAL] Uh, you went out. What was that?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] You went out. What was that?
[AGENT][NEUTRAL] The maximum amount payable for the occurrence has been met, so the claim is denied.
[CUSTOMER][NEUTRAL] OK, may I have the maximum amount payable?
[AGENT][NEUTRAL] The maximum amount payable is
[AGENT][NEUTRAL] It's 500.
[CUSTOMER][NEUTRAL] Is it 500 per month or year?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Well, no, it's not per year, it's per occurrence.
[AGENT][NEUTRAL] So, occurrence would be anything treated for in a ninety-day time period.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know when it was me?
[AGENT][NEUTRAL] Um, I can just give you claim status on the claim that you're calling about.
[AGENT][NEUTRAL] So it, it was met in a 90 day time period.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Did you have any other questions?
[CUSTOMER][NEUTRAL] Um, may I have the date on which the
[AGENT][NEUTRAL] It was met prior to when this claim was submitted in a ninety-day time period.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm, may I have the call reference?
[AGENT][NEUTRAL] Uh it's my name, [PII] and today's date.
[CUSTOMER][POSITIVE] Thank you for your assistance. Have a good one.
[AGENT][POSITIVE] Thanks for calling APL. You as well. Bye-bye.