AccountId: 011433970860
ContactId: 231fdd38-d0ab-4088-bba0-7e566421c73a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 236020 ms
Total Talk Time (AGENT): 72548 ms
Total Talk Time (CUSTOMER): 102847 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/231fdd38-d0ab-4088-bba0-7e566421c73a_20250218T20:27_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] Good afternoon. This is [PII] calling from provider's office to check up on a claim status. Also, this call has been recorded for quality and training purposes. Are you OK with that?
[AGENT][POSITIVE] Sure, yes, I can assist you with claim statuses. May I have a callback number just in case we get disconnected?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh, sure, it would be uh sorry, it would be [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Uh, sure, just a moment.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, the patient's policy number would be 017394.
[CUSTOMER][NEUTRAL] 99
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima number 8.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Uh, yeah, the name of the member would be [PII], and the date of birth would be [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] What is the service and the amount of the claim?
[CUSTOMER][NEUTRAL] Date of service would be [PII] and total charge $3500 even. And actually, I do have specific concern with the claim.
[AGENT][NEUTRAL] OK, and that was [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] One moment, let me pull the policy and the claim I'm sorry.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] And what are your concerns about this claim?
[CUSTOMER][NEUTRAL] Actually here it shows the claim has been paid with $1,635.50 and the remaining amount which is $60.02 is denied as maximum benefit me. So I just need to know why it has been denied as maximum benefit. Like is there any limit in dollar value or is this value anything?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, the benefit maximum has been met for the year, um, the policy has a calendar year maximum of 2000.
[AGENT][NEUTRAL] For any outpatient service.
[CUSTOMER][NEUTRAL] And uh was it?
[CUSTOMER][NEUTRAL] OK. And was it uh
[CUSTOMER][NEUTRAL] Paid previously?
[AGENT][NEUTRAL] By the time we received your claim, she only had $1,635.50 left, which is what we send out.
[CUSTOMER][NEUTRAL] Any
[AGENT][NEUTRAL] For this payment.
[CUSTOMER][POSITIVE] OK, OK, sure, thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much. Uh, yeah, I need call reference number for this one only.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will. Do you need the spelling of my name or any other information, Miss [PII]?
[CUSTOMER][NEUTRAL] Yeah, please uh can you spell out your name for me?
[AGENT][NEUTRAL] Sure, that is so. That's [PII]. Last initial [PII].
[CUSTOMER][POSITIVE] OK, thank you so much for your help. That's it for the day. Hope you have a wonderful day.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] Thank you you as well thank you for calling APO bye bye.
[CUSTOMER][POSITIVE] Take care. Bye-bye.
[AGENT][NEUTRAL] No.