AccountId: 011433970860
ContactId: 3066aa48-6436-489a-bfd1-b7965356ee92
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 641580 ms
Total Talk Time (AGENT): 92177 ms
Total Talk Time (CUSTOMER): 89884 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/3066aa48-6436-489a-bfd1-b7965356ee92_20250616T19:24_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. My name is [PII] calling from Mercy Hospital for checking on claims.
[AGENT][NEUTRAL] Alright [PII], happy to check on a claim. Can I get the policy number?
[CUSTOMER][NEUTRAL] Yeah, Policy number of 01835841.
[AGENT][NEUTRAL] Thank you and for documentation, do you have a good callback number?
[CUSTOMER][NEUTRAL] Uh, sorry, could you please repeat it again?
[AGENT][NEUTRAL] Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] May I please have it for documentation?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] What is the patient name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, my first name is [PII]. Date of birth of [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] It's uh [PII] and [PII].
[AGENT][NEUTRAL] Filled them out.
[CUSTOMER][NEUTRAL] Yeah, just bring it up.
[CUSTOMER][NEUTRAL] Yes, it's for $3,801 even.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] This claim was received [PII].
[AGENT][NEUTRAL] The claim was denied [PII].
[AGENT][NEUTRAL] We need the primary EOB.
[CUSTOMER][NEUTRAL] And may I know the claim number, please?
[AGENT][NEUTRAL] 351.
[AGENT][NEUTRAL] 8149.
[CUSTOMER][NEUTRAL] So, did you send a letter to member?
[AGENT][NEUTRAL] Yes, it would have been sent to a member correct.
[CUSTOMER][NEUTRAL] May I know when the first letter was sent to November?
[AGENT][NEUTRAL] On the process date of [PII].
[CUSTOMER][NEUTRAL] And the second was unknown?
[AGENT][NEUTRAL] I'm sorry, what was that again?
[CUSTOMER][NEUTRAL] So, did you send any 2, 2nd letter?
[AGENT][NEUTRAL] Yes, an EOB would have been sent to the insured on [PII] when the claim was processed.
[CUSTOMER][NEUTRAL] And the call reference, please, so that we can run for the next member.
[AGENT][NEUTRAL] That would be my name with today's date.
[CUSTOMER][POSITIVE] Yeah, let's go on for the next number.
[AGENT][NEUTRAL] Policy number?
[CUSTOMER][NEUTRAL] Yeah, just.
[CUSTOMER][NEUTRAL] Yeah, it's uh 0251.
[CUSTOMER][NEUTRAL] 2472.
[AGENT][NEUTRAL] I'm sorry, repeat that once more, 02.
[CUSTOMER][NEUTRAL] It's 0251.
[CUSTOMER][NEUTRAL] 2472.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, my first name is [PII].
[CUSTOMER][NEUTRAL] [PII], date of birth of [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] Yeah, for data service of [PII].
[AGENT][NEUTRAL] Built them out.
[CUSTOMER][NEUTRAL] Yeah, it's uh $3,589 even.
[AGENT][NEUTRAL] Claim was received [PII].
[AGENT][NEUTRAL] The claim was denied on [PII].
[AGENT][NEUTRAL] The maximum benefit for the state of
[CUSTOMER][NEUTRAL] Is it [PII]?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Ma'am, is it [PII]. Yeah, please go ahead. And the claim number, please?
[AGENT][NEUTRAL] 3508192
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The benefit maximum for the date of service had been met.
[CUSTOMER][NEUTRAL] May I know what is the available units or the services for the member?
[AGENT][NEGATIVE] Uh, the max benefit is it looks like $150 and that was exhausted.
[CUSTOMER][NEUTRAL] Is it per year for $150?
[AGENT][NEUTRAL] Uh, it was per visit.
[CUSTOMER][NEUTRAL] And may I know when the last visit was used?
[AGENT][NEUTRAL] It was for the date of service of [PII].
[CUSTOMER][POSITIVE] Yeah, OK. Thank you so much for asking, ma'am. Have a good day. Bye for now.