AccountId: 011433970860
ContactId: 2a978f0c-82dc-4fe3-b2f6-619bd9a43408
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 457489 ms
Total Talk Time (AGENT): 97868 ms
Total Talk Time (CUSTOMER): 107358 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/2a978f0c-82dc-4fe3-b2f6-619bd9a43408_20250617T16:29_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Oh hi, this is [PII] calling from the provider's office to check for the claim status.
[AGENT][NEUTRAL] OK. What was your name? I'm sorry.
[CUSTOMER][NEUTRAL] It's [PII], and you said your name is [PII], right?
[AGENT][NEUTRAL] Yes, [PII]
[AGENT][NEUTRAL] Do you have a phone number I can get in case we
[CUSTOMER][NEUTRAL] Initial fora.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Do you have a phone number I can get in case we get disconnected I can call you back.
[CUSTOMER][NEUTRAL] Yeah, sure. That is [PII] and it is a direct line.
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK. And do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, I do have the policy number. That is
[CUSTOMER][NEUTRAL] D as in Delta 473-05927.
[AGENT][NEUTRAL] That's not one of our policy numbers. Do you have the Social Security number?
[CUSTOMER][NEUTRAL] Yes, I do have the social security number. Just a second.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] The Social Security number, it is [PII].
[AGENT][POSITIVE] Thank you, [PII]. Hold on one moment please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And what's the patient's name?
[CUSTOMER][NEUTRAL] The patient's name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And can I verify her date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII], and you were needing claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I can help you with that. What date of service was it for?
[CUSTOMER][NEUTRAL] Uh, the date of service it is for.
[CUSTOMER][NEUTRAL] [PII] with a bill amount of $996.
[AGENT][NEUTRAL] 996. Hold on one moment.
[AGENT][NEGATIVE] OK, we did get that claim in and it was denied. Benefit maximum for this data service has been met.
[AGENT][NEUTRAL] So they had met their maximum.
[CUSTOMER][NEUTRAL] Mm, may I know when was the claim received?
[AGENT][NEUTRAL] Hold on just a moment, I can tell you.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] It was received 325 of 25.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] It was denied.
[CUSTOMER][NEUTRAL] When was it denied?
[AGENT][NEUTRAL] 3:31.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And that is denied as benefit.
[AGENT][NEUTRAL] Benefit maximum for that data service has been met.
[CUSTOMER][NEUTRAL] Is that, uh, is that visit or your next?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Visit
[CUSTOMER][NEUTRAL] May I know how many?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] 2 visits at $100.
[CUSTOMER][NEUTRAL] Member has 2 visits and $100 per calendar year, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Member has completely met the 22 visits for before the date of service.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Can I also have the claim number?
[AGENT][NEUTRAL] 3582717
[CUSTOMER][NEUTRAL] 3582717. Correct?
[AGENT][POSITIVE] Correct. Mhm.
[CUSTOMER][NEUTRAL] Uh, can you please just fax the UV for the same?
[AGENT][NEUTRAL] What's the fax number?
[CUSTOMER][NEUTRAL] The fax number, it is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, I'll fax that to you.
[CUSTOMER][NEUTRAL] Can you please give me the call reference number for this?
[AGENT][NEUTRAL] We do not have call reference numbers. You can use my name in today's date.
[CUSTOMER][POSITIVE] Thank you so much. Thank you so much for assisting all my queries. Have a great day.
[AGENT][POSITIVE] Thank you, [PII] for calling APL. You have a good day.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm. Bye-bye.