AccountId: 011433970860
ContactId: 4b92a75e-0034-4a86-a47e-de8e0b1c2a58
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 248289 ms
Total Talk Time (AGENT): 97266 ms
Total Talk Time (CUSTOMER): 52403 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/4b92a75e-0034-4a86-a47e-de8e0b1c2a58_20250408T18:06_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] from Tri Health. I'm calling to check claim status on a patient.
[AGENT][NEUTRAL] Hey, [PII], I'm happy to check on the claim for you. What's the patient's policy number?
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] D 41203369
[AGENT][NEUTRAL] Unfortunately I can't pull the number with that number. Do you have the claim number or their name? I can check with that or social.
[CUSTOMER][NEUTRAL] Um, I have their name Author [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII] is the last name.
[CUSTOMER][NEUTRAL] [PII], yeah.
[AGENT][NEUTRAL] First name is [PII].
[CUSTOMER][NEUTRAL] That's the uh
[CUSTOMER][NEUTRAL] Child's name do you need the subscriber name?
[AGENT][NEUTRAL] Um, what's, do you have the subscriber's first name?
[CUSTOMER][NEUTRAL] Uh, yes, [PII].
[AGENT][NEUTRAL] You know
[AGENT][NEUTRAL] What state do they live in?
[CUSTOMER][NEUTRAL] [PII], oh well.
[CUSTOMER][NEUTRAL] Oh [PII].
[AGENT][NEUTRAL] It's OK. OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see here
[AGENT][NEUTRAL] What is um [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I found them here.
[AGENT][NEUTRAL] And let's see, what's the date of service?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then bail them out.
[CUSTOMER][NEUTRAL] $143.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so looks like we did receive the claim. It looks like it was denied. It looks like the outpatient sickness was maxed out, so.
[AGENT][NEUTRAL] Maxed out visits 5 per adult per calendar year, so it looks like they had used all of their visits for the year.
[CUSTOMER][NEUTRAL] It's 5 per year.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so this would go to the patient?
[AGENT][NEUTRAL] Yeah, I mean, as far as patient responsibility, that's up to the provider facility to build them.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is this a self funded plan?
[AGENT][NEUTRAL] Uh, let's see
[AGENT][NEUTRAL] Uh, it looks like they do have it through their employer. It is a limited benefit plan, so it only pays just the set amount and has a set visits, nothing additional. It's not a major medical.
[CUSTOMER][NEUTRAL] Medical plan, OK.
[CUSTOMER][POSITIVE] Great thank you I appreciate your time do you have a reference number?
[AGENT][NEUTRAL] Yeah, absolutely. Call references my name with my last initial than today's date. My name again is [PII], which is [PII].
[CUSTOMER][POSITIVE] Great thank you I appreciate your help.
[AGENT][POSITIVE] You're welcome, [PII]. Have a good day.
[CUSTOMER][NEUTRAL] You too uh huh bye.
[AGENT][NEUTRAL] Bye-bye.