AccountId: 011433970860
ContactId: 22e44700-710c-41fd-b923-53ddb2533012
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 297130 ms
Total Talk Time (AGENT): 112641 ms
Total Talk Time (CUSTOMER): 81374 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/22e44700-710c-41fd-b923-53ddb2533012_20250409T17:50_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah, hi, uh, good afternoon. My name is [PII], and last time in for [PII]. I'm calling from provider's office regarding the claim status.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status, Mr. [PII]. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. [PII]. It is a direct line.
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number, Mr. [PII]?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] OK, the policy number is 01867131 M for Mary, L for Lima 8.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the date of [PII].
[AGENT][NEUTRAL] OK, thank you. What is the date of service and the amount of the claims?
[CUSTOMER][NEUTRAL] Uh, it's 7 1020 24 and the total charge $131 even.
[AGENT][NEUTRAL] OK. Let me see if I can find this claim for you and for the future, you can check claim status online through our website at [PII] and that's just optional. And you said the date of service was [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] All right, let's see 131. OK. Looks like we have processed this 3 times, so I'm gonna give you the original, OK.
[CUSTOMER][NEUTRAL] Can you please provide the original claim status?
[AGENT][NEUTRAL] Yes, one moment.
[AGENT][NEUTRAL] Let me pull the image.
[AGENT][NEUTRAL] OK, so it looks like the original claim was processed [PII].
[AGENT][NEUTRAL] And the claim was denied, the denial reason is that inpatient benefits for the calendar year has been met.
[CUSTOMER][NEUTRAL] OK, like it's benefits Maxine existed?
[AGENT][NEUTRAL] It means that it was exhausted for the year and if it has been exhausted for the year.
[CUSTOMER][NEUTRAL] OK. How many times bill per year? Like uh one time or 2 times?
[AGENT][NEUTRAL] It's not about time, it's about the maximum benefit of the policy. So let me check and see.
[AGENT][NEUTRAL] On the policy maximum was 3500 per calendar year. When we received this claim, she already used all her benefits.
[CUSTOMER][NEUTRAL] OK, $2 a month maximum benefits existed by $1 a month.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you please provide the claim number?
[AGENT][NEUTRAL] Yes, the claim number is 3508225.
[CUSTOMER][NEUTRAL] OK, one second.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, I got it. And can you please provide the claim, receive date and claim? You already processed it provided, right? [PII].
[AGENT][NEUTRAL] Yes, [PII] is the process date.
[CUSTOMER][NEUTRAL] When I received it?
[AGENT][NEUTRAL] OK, let me get that for you. That's not on the AOB. One moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, that's 85.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so it was received [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you spell your name?
[AGENT][NEUTRAL] My name is [PII], that's [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] May I know the call reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][POSITIVE] Yeah. Thank you. And thank you for giving this information. Have a nice day.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] You're as well. Thank you for calling APL. Bye bye Miss [PII].
[CUSTOMER][NEUTRAL] Yeah bye bye.