AccountId: 011433970860
ContactId: 2afbdbbe-2f02-4289-9064-87bf4f4feb6d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 167130 ms
Total Talk Time (AGENT): 74285 ms
Total Talk Time (CUSTOMER): 54652 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/2afbdbbe-2f02-4289-9064-87bf4f4feb6d_20250121T18:17_UTC.wav
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[AGENT][NEUTRAL] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider office. Actually, I have a claim which previously got denied. So want to help in that.
[AGENT][NEUTRAL] Can I have your name again, please? Your name again and a callback number.
[CUSTOMER][NEUTRAL] My name is [PII]. Last initial to my last name is [PII], and the callback number is [PII].
[AGENT][NEUTRAL] And the policy number?
[CUSTOMER][NEUTRAL] Yeah, it's 01633180.
[AGENT][NEUTRAL] And did you say your name was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Is this for dental or medical?
[CUSTOMER][NEUTRAL] It's a medical
[AGENT][NEUTRAL] Could you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] And what is the date of service that you're inquiring claim status for?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what is your procedure code?
[AGENT][NEUTRAL] Just one.
[CUSTOMER][NEUTRAL] It's 99204.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] 1001.
[AGENT][NEUTRAL] This claim was received [PII].
[AGENT][NEUTRAL] 2024 was processed [PII]. There was no payment made on this claim, and the reason why there was no payment?
[AGENT][NEUTRAL] It's because outpatient sickness rider benefits were exhausted.
[AGENT][POSITIVE] And no charge for services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So how much the, for the CBD is allowed for the patient?
[AGENT][NEUTRAL] The member's policy covers the outpatient benefits of $100 per calendar year $100 per visit with 5 visits per calendar year. By the time your claims were submitted, the policy exhausted the benefits.
[CUSTOMER][NEUTRAL] OK. So the patient has already visited 5 times before this, right?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, that is correct, [PII].
[CUSTOMER][NEUTRAL] OK. Uh, when's the last visit, could you please tell me?
[AGENT][NEUTRAL] I can't provide you that information because it's not pertaining to your claim.
[CUSTOMER][POSITIVE] OK, no problem. Thank you. May I know your name, please?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] My name is [PII] and today's date as a reference because we don't provide reference numbers. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] No, thank you, [PII]. Thank you for your help.
[AGENT][POSITIVE] Thanks for calling APL. Have a good day. Bye.