AccountId: 011433970860
ContactId: 27bf267f-85b7-4acf-b62e-feb6c86a91c7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 606919 ms
Total Talk Time (AGENT): 133074 ms
Total Talk Time (CUSTOMER): 163353 ms
Interruptions: 2
Overall Sentiment: AGENT=1.2, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/27bf267f-85b7-4acf-b62e-feb6c86a91c7_20250513T17:37_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from provider's office. I'm here to check claim. Could you please help me with that?
[AGENT][NEUTRAL] Yes, No, I can help you with claim status. May I please get your callback number, sir, just in case the call is disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII].
[AGENT][NEUTRAL] Thank you. And then what is the member's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Sure. My policy number is 2560005.
[CUSTOMER][NEUTRAL] And member's name is?
[CUSTOMER][NEUTRAL] [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. All right, I've got Guadalupe's.
[AGENT][NEUTRAL] Policy pulled up and what is uh the date of service for her and the charge amount?
[CUSTOMER][NEUTRAL] So, date of service is [PII] and the charge amount is $682 even.
[AGENT][NEUTRAL] OK, and what is the name of the facility you're calling from please, [PII]?
[CUSTOMER][NEUTRAL] Southern California permanent.
[AGENT][POSITIVE] OK, thank you so much. I'm gonna put you on a brief hold while I look up this claim for you and I'll be right back, sir.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, No. I have your claim information for you.
[AGENT][NEUTRAL] The claim number
[AGENT][NEUTRAL] Is 359-522-0.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the claim has been denied because the calendar year benefits have been maxed out.
[CUSTOMER][NEUTRAL] OK, may I know when the benefits are maxed out for the calendar year?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh, looks like.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] That a lot of.
[AGENT][NEUTRAL] It looks like they were maxed out on the same day.
[AGENT][NEUTRAL] For other claims that were sent on that that thing the service.
[CUSTOMER][NEUTRAL] OK. May I know that claim number?
[AGENT][NEUTRAL] No, it's facility.
[CUSTOMER][NEUTRAL] It is a different facility, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, for that you know how many uh
[CUSTOMER][NEUTRAL] Sickness treatment is followed for.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, let me look real quick.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Gonna be just a moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] The.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I you.
[CUSTOMER][NEUTRAL] 84566244.
[CUSTOMER][NEUTRAL] And for what?
[AGENT][NEUTRAL] OK, the member gets 2 visits per calendar year, and this is just to verify benefits. It's not a guarantee of payment. Each visit pays $100 and she gets $2 per year.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you so much. I have another, uh, one claim to verify with you for the same patient. Could you please help me with that also?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, sir. What is the date of service?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, sure, the next date of service is.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And the bill amount?
[CUSTOMER][NEUTRAL] That's why
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Well, the amount is $682 even.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold. Is it for the same facility?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. I'm gonna put you on a quick hold while I look it up and I'll be right back with you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me, [PII]. I have the claim information ready for you. The claim number is 359-521-7 and the claim was denied for the same reason.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, it is also for the same reason.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, thank you so much. Could you please spell out your name?
[AGENT][NEUTRAL] Yes, sir. It's [PII]
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK, thank you so much. Uh, may I know the call reference number for this call?
[AGENT][NEUTRAL] Yes, you can use my name and today's date.
[CUSTOMER][POSITIVE] OK, thank you so much for your support. Have a nice day.
[AGENT][POSITIVE] You have a wonderful day too, [PII]. Is that everything I can help you with?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right. Well you take
[CUSTOMER][POSITIVE] And thank you so much for your support.
[AGENT][POSITIVE] Thank you. You take care. Thanks for calling APL. Bye-bye, sir.