AccountId: 011433970860
ContactId: 45cb7541-6272-4d57-b996-977846ccce58
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 261100 ms
Total Talk Time (AGENT): 68310 ms
Total Talk Time (CUSTOMER): 95432 ms
Interruptions: 2
Overall Sentiment: AGENT=-0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/45cb7541-6272-4d57-b996-977846ccce58_20250612T17:03_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] and I'm calling on behalf of Cleveland Clinic Foundation to check up on a claim.
[AGENT][POSITIVE] I'd be happy to assist with claim status. I'm good. I'd be happy to assist with claim status today, [PII], if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] How are you doing today, [PII]?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] And what
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Yeah, it's 01634855 M as in Mary, L as in Lima, 8.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that information and what is the date of service for the claim?
[CUSTOMER][NEUTRAL] Yeah, it's on [PII].
[CUSTOMER][NEUTRAL] And total amount bill is $506 even.
[AGENT][NEUTRAL] And what's the tax ID?
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] What's the procedure called?
[CUSTOMER][NEUTRAL] It's uh 00918.
[AGENT][NEUTRAL] OK, I'm showing that claim was denied.
[AGENT][NEUTRAL] Because the maximum outpatient benefits had already been exhausted.
[CUSTOMER][NEUTRAL] And have
[CUSTOMER][NEUTRAL] So it, uh, the number of outpatient benefits in terms of visits have exhausted, right?
[AGENT][NEGATIVE] The dollar amount exhausted.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what's the
[CUSTOMER][NEUTRAL] Maximum dollar amount allowed.
[AGENT][NEUTRAL] 1000 per year.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] When did the, like, when was the dollar amount made last?
[AGENT][NEUTRAL] [PII]. [PII] to a different provider.
[CUSTOMER][NEUTRAL] last May date.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, but our, our claims data services, our claims data of service is [PII].
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] W
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Her benefits maxed out [PII]. We received your claim [PII], so other claims were paid out to other providers. Her benefit was maxed out.
[CUSTOMER][NEUTRAL] Within
[AGENT][NEGATIVE] By the time we got your claim, so it denied.
[CUSTOMER][NEUTRAL] OK. When did you receive all
[CUSTOMER][NEUTRAL] OK. And when did you receive our claim?
[AGENT][NEGATIVE] We received your claim [PII]. It did not [PII].
[CUSTOMER][POSITIVE] Well, thanks a lot sir for providing me all the information. Could you please provide me the claim number?
[AGENT][NEUTRAL] Claim number is 3,324,480.
[CUSTOMER][NEUTRAL] OK, thanks a lot, [PII], and could you please generate the call reference number for our call.
[AGENT][NEUTRAL] Reference is just my name [PII] last initial [PII] as in [PII], and the date and time of the call. Was there anything else I could assist with today?
[CUSTOMER][POSITIVE] That's it, [PII]. Thanks a lot for your kind help and assistance today. Have a wonderful day ahead. Take care and be safe.
[AGENT][POSITIVE] Thank you for calling APL have a good day.
[CUSTOMER][NEUTRAL] Uh huh.