AccountId: 011433970860
ContactId: 1e3b7c44-f61f-45c9-89a0-a91451ff5043
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 297540 ms
Total Talk Time (AGENT): 100637 ms
Total Talk Time (CUSTOMER): 96339 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/1e3b7c44-f61f-45c9-89a0-a91451ff5043_20250213T16:31_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling A. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] Hi, [PII], this is [PII] calling to check on a claim status.
[AGENT][POSITIVE] OK, and I'll be more than happy to assist you with the claim status, [PII], and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] I just have 4, that's it.
[AGENT][NEUTRAL] And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, that is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the first member's policy number?
[CUSTOMER][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] That's going to be 02445466. Can I have your name once again?
[AGENT][NEUTRAL] Yes, my name is [PII]. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome and can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure, that's going to be.
[CUSTOMER][NEUTRAL] [PII] for the date of birth, [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bills for the claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] It's going to be.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I have you go home. One moment.
[CUSTOMER][NEUTRAL] [PII], the amount of $840 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] $840.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Not 850.
[CUSTOMER][NEUTRAL] 0, 8:50. Sorry about that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the name of the provider's office, I'm sorry.
[CUSTOMER][NEUTRAL] uh Wellston Medical Group.
[AGENT][NEUTRAL] So I'mine received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 35 I'm 353.
[AGENT][NEUTRAL] 6150.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And also on [PII], the claim was denied?
[AGENT][NEUTRAL] And hold on one moment, I'm getting that reason for you now.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um, the calendar year maximum for the accident and sickness surgery benefit has been, um, met for the calendar year.
[CUSTOMER][NEUTRAL] So it has been exhausted, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. As for the visit.
[AGENT][NEUTRAL] Um, the dollar amount.
[CUSTOMER][NEUTRAL] OK, so as per dollar.
[CUSTOMER][NEUTRAL] OK. Do you have the information regarding how much they have met?
[CUSTOMER][NEUTRAL] And how much is the?
[AGENT][NEUTRAL] The accident and surgery benefit.
[AGENT][NEUTRAL] Um, hold on one moment. It's up to $1000 per calendar year?
[AGENT][NEUTRAL] One per calendar year.
[AGENT][NEUTRAL] They would pay towards us
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, one moment, uh dollar.
[CUSTOMER][NEUTRAL] Uh, how much, so they have met the amount, right?
[AGENT][NEUTRAL] I'm sorry, yes, they have, by the time your claim came in, they had already used that benefit and it's one per calendar year.
[CUSTOMER][NEUTRAL] OK. Thank you. One moment, please.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Mm, the thing.
[CUSTOMER][NEUTRAL] Mm. So, uh, is there any other insurance on file? Any active insurance?
[AGENT][NEUTRAL] And like medical insurance for APL, this is the only policy they have with us.
[CUSTOMER][NEUTRAL] OK, for medical. OK. May I get the, uh, one moment, please.
[CUSTOMER][NEUTRAL] May I get the reference number for this conversation, please?
[AGENT][NEUTRAL] The reference number for the entire call will be my name and today's date, and that's [PII], and then today's date.
[CUSTOMER][POSITIVE] Thank you so much for this assistance. Wish you have a great day. Bye-bye.