AccountId: 011433970860
ContactId: 4140c2e3-e89b-4c11-b0f5-fb44dff0e055
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 267640 ms
Total Talk Time (AGENT): 59411 ms
Total Talk Time (CUSTOMER): 78000 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/4140c2e3-e89b-4c11-b0f5-fb44dff0e055_20250528T19:29_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. Last name initial [PII], and I would like to know about the claim.
[AGENT][NEUTRAL] OK, what is the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah. Patient's policy ID is 945137.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] [PII], date of birth is on [PII].
[AGENT][NEUTRAL] And data service.
[CUSTOMER][NEUTRAL] Data service on.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the build them out?
[CUSTOMER][NEUTRAL] $742.50.
[AGENT][NEUTRAL] Alright, one moment please.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Really.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Alright, so it looks like we did receive a claim for the state of service on [PII].
[AGENT][NEUTRAL] Claim was processed and denied [PII].
[AGENT][NEUTRAL] Uh, the calendar year maximum, which is 4 office visits per year, had already been met, so there was nothing additional payable.
[CUSTOMER][NEUTRAL] OK, so, uh, one moment.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Just give me one moment.
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] OK. Um, can you repeat the denial reason? Maximum benefits as exhausted. I, I, is it on the dollar value?
[AGENT][NEUTRAL] Uh, patient has allowed 4 office visits in a calendar year. Those had been exhausted.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got it. So how much does this patient has exhausted already?
[AGENT][NEUTRAL] They'd already used their 4 visits.
[CUSTOMER][NEUTRAL] OK. OK, thank you so much. So, uh, this claim is not appealable or um we cannot send any corrected claim, is that correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, thank you so much, [PII], and could I get the call reference number?
[AGENT][NEUTRAL] Call reference is my name with my last initial and today's date. My name is [PII], that's [PII]
[AGENT][NEUTRAL] Last in initial is [PII].
[AGENT][NEUTRAL] And then today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much for your assistance and yeah, that's all I have for now. Thank you.
[AGENT][POSITIVE] You're welcome bye bye.
[CUSTOMER][NEUTRAL] Bye bye.