AccountId: 011433970860
ContactId: 4bcdd8e6-ad5d-4c38-973d-8f2acead9b12
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 214039 ms
Total Talk Time (AGENT): 108338 ms
Total Talk Time (CUSTOMER): 50584 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/4bcdd8e6-ad5d-4c38-973d-8f2acead9b12_20250421T13:18_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII]. I'm calling from provider's office checking on the claim denial clarification.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the claim denial clarity, and [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yeah, that is [PII]. Policy number is 02156805.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Member name is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have either the date of service or the claim number for the claim?
[CUSTOMER][NEUTRAL] Yes, so the claim number is 3587141.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Dynamic Radiy Tennessee.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] This is for data service [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you. I'm just asking because there's multiple claims. Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] OK mhm.
[AGENT][NEUTRAL] OK, so the claim was denied because the maximum benefit for the data service has been met and what question did you have?
[CUSTOMER][NEUTRAL] Uh, when was the last met there?
[AGENT][NEUTRAL] So that's saying that for the date of service, [PII], that is the date.
[AGENT][NEUTRAL] So the benefit is $50 for, go ahead.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, yeah, you, you go ahead.
[AGENT][NEUTRAL] Thank you. So the benefit is um up to $50 for the emergency room, 2 times per calendar year.
[AGENT][NEUTRAL] So on [PII], hold on, let me go back to it.
[AGENT][NEUTRAL] We received the ER charge 3 times. So the first claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me make sure this is yours before I give it. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, OK, so.
[AGENT][NEUTRAL] So there are different um providers that submitted a claim from [PII]. So there was a claim that came in before your claim and the $50 was applied to that claim. So we couldn't pay it out anymore because for that day, the $50 had been used.
[CUSTOMER][POSITIVE] OK, OK, thank you so much. May I get the call reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name and today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK, thank you so much for helping me today. Have a wonderful day. Bye for now.
[AGENT][POSITIVE] You're welcome, [PII], and thanks for calling APL. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm.