AccountId: 011433970860
ContactId: 2168bec8-dd5c-4dac-8731-1e8e1b25a7cd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 217100 ms
Total Talk Time (AGENT): 90411 ms
Total Talk Time (CUSTOMER): 57888 ms
Interruptions: 1
Overall Sentiment: AGENT=2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/2168bec8-dd5c-4dac-8731-1e8e1b25a7cd_20250106T18:44_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, this is [PII]. I'm calling with Ensemble. How are you?
[AGENT][POSITIVE] I'm doing well how are you?
[CUSTOMER][NEUTRAL] Doing all right. I just want to check the status of a claim, please.
[AGENT][POSITIVE] Yeah, I can check on a claim for you. I'm so sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] [PII] and my last initial is [PII]
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Got it, thank you. And can, can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] It is 024909997.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][NEUTRAL] OK, thank you for verifying that [PII] uh what was the date of service for this claim?
[CUSTOMER][NEUTRAL] D of service is [PII].
[CUSTOMER][NEUTRAL] An amount of $1180.
[AGENT][POSITIVE] OK, thank you one moment please.
[AGENT][NEUTRAL] Bear with me just a moment. Looks like I had a few claims for that day. Um, I'm sorry, what was the name of the provider's office you're with [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, I'm with Ensemble and calling on behalf of Carillion Clinic.
[AGENT][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alrighty, so yes, I did find this claim. Let's take a look here.
[AGENT][NEUTRAL] OK, so for the item 99223, we were unable to pay a benefit as office visits are not covered under this policy.
[AGENT][NEUTRAL] The second the procedure code 43246, they had met their maximum for that benefit so we weren't able to pay on this claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] Did you need that claim number or EOB?
[CUSTOMER][POSITIVE] All right, I will make it.
[CUSTOMER][NEUTRAL] Yes, please. What's the claim number?
[AGENT][NEUTRAL] Yes, claim number is 351-6549.
[CUSTOMER][NEUTRAL] OK. All right. And then, um, what date was that processed?
[AGENT][NEUTRAL] Uh, give me just a moment.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] OK, so this claim was processed [PII].
[CUSTOMER][NEUTRAL] OK. All right. All right, [PII], and do you have a call reference number for today?
[AGENT][NEUTRAL] Yeah, reference number would just be my first name, last initial, and today's date and so my last initial is A.
[CUSTOMER][NEUTRAL] And what it
[CUSTOMER][POSITIVE] OK, OK. All right, [PII], I appreciate your help today. Thank you.
[AGENT][POSITIVE] Yes, was there anything else I can help you with? Yeah.
[CUSTOMER][NEUTRAL] That's all right now.
[AGENT][POSITIVE] Alright, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] Thank you bye bye.