AccountId: 011433970860
ContactId: 4cb126fc-5852-4811-886d-4b9faf6a4ae5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 721849 ms
Total Talk Time (AGENT): 105854 ms
Total Talk Time (CUSTOMER): 201065 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/4cb126fc-5852-4811-886d-4b9faf6a4ae5_20250523T18:24_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. My name is [PII] and I need your assistance to look over the claims.
[AGENT][NEUTRAL] OK, [PII], Happy to check a claim. What's the policy number?
[CUSTOMER][NEUTRAL] 02012930 Mike Lima 7.
[AGENT][NEUTRAL] Thank you. And then if I can have patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient is [PII] [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Thank you and then what's the date of service?
[CUSTOMER][NEUTRAL] We have uh [PII].
[AGENT][POSITIVE] Thank you and the build amount?
[CUSTOMER][NEUTRAL] Chip.
[CUSTOMER][NEUTRAL] $50 even.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know your name it's spelled?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What's your initial?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] You have to be.
[AGENT][NEUTRAL] So the claim is received on [PII].
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Claim was denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The max benefit payable for this date of service has already been met.
[CUSTOMER][POSITIVE] Benefits maxed out.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, may I know was that with the dollar wise or visit wise?
[AGENT][NEUTRAL] Dollar.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Give me a moment, please give me a second.
[CUSTOMER][NEUTRAL] In this case what I need to do with the second due amount.
[CUSTOMER][NEUTRAL] So they need to go on a pill or I need to go with the patient bill?
[AGENT][NEUTRAL] It's up to the facility or provider to um designate patient responsibility we are not able to advise on that.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Good
[CUSTOMER][NEUTRAL] And uh can I have this uh.
[CUSTOMER][NEUTRAL] Patient plan name?
[AGENT][NEUTRAL] We are the secondary, it is a med link plan.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] H M O P P O E P O.
[AGENT][NEUTRAL] Neither. It's a secondary, so it's a meddling plan. It's a gap insurance.
[CUSTOMER][NEUTRAL] Yeah, give me a second.
[CUSTOMER][NEUTRAL] Can you please fax the UOB to my fax?
[AGENT][NEUTRAL] What is the fax number?
[CUSTOMER][NEUTRAL] It's uh 561.
[CUSTOMER][NEUTRAL] 303.
[CUSTOMER][NEUTRAL] 2133, you got it?
[AGENT][NEUTRAL] Got it.
[AGENT][NEUTRAL] EOB should be there in about 5 minutes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK, please give me a second.
[CUSTOMER][NEUTRAL] Please give me a sec.
[CUSTOMER][NEGATIVE] Oh shit
[CUSTOMER][NEUTRAL] Can I get the claim number?
[AGENT][NEUTRAL] 3594895
[CUSTOMER][NEUTRAL] 4895.
[CUSTOMER][NEUTRAL] And can we move to the next claim with the different patient?
[AGENT][NEUTRAL] Uh, you'll need to let me finish with this one and then we can check another 11 moment.
[CUSTOMER][NEUTRAL] One please.
[CUSTOMER][NEUTRAL] 7
[CUSTOMER][NEUTRAL] Can I have that number?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Can I have mode of transaction it was for you.
[AGENT][POSITIVE] OK, I'm ready for the next policy number when you are.
[CUSTOMER][NEUTRAL] Sure, sir. I have 02168608, [PII] 8 sorry, number 8.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] [PII] so.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 15
[AGENT][NEUTRAL] In the bill amount?
[CUSTOMER][NEUTRAL] $250 even.
[CUSTOMER][NEUTRAL] 9
[AGENT][NEUTRAL] This claim was received on [PII].
[AGENT][NEUTRAL] Claim was denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] Can have.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You don't cover this office visits for this plan?
[AGENT][NEUTRAL] Office visits are not covered under the plan, correct.
[CUSTOMER][NEUTRAL] May I know the patient plan name?
[AGENT][NEUTRAL] Or the secondary insurance, the gap insurance.
[CUSTOMER][NEUTRAL] OK but.
[CUSTOMER][NEUTRAL] Can you attach the COB also?
[AGENT][NEUTRAL] Same fax?
[CUSTOMER][NEUTRAL] Uh, same facts and same attention to my name.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Please.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. EOB is on its way. Anything else you needed from us?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 1 2nd for this one.
[CUSTOMER][NEUTRAL] I need the policy.
[CUSTOMER][NEUTRAL] Give me a second and let me have one sec.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And is this also a med gap something like that, uh, do you mind to HMO PPO like that in a specific mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's a secondary gap plan, so it's a, it's a meddling plan.
[CUSTOMER][NEUTRAL] I'm not looking this then this.
[CUSTOMER][NEGATIVE] Understood, but it is not coming with my sister.
[CUSTOMER][NEUTRAL] On the
[CUSTOMER][NEUTRAL] Supplemental med link.
[CUSTOMER][NEUTRAL] Meddling, right?
[CUSTOMER][NEUTRAL] Can we need another data service.
[CUSTOMER][NEUTRAL] A claim number please.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Sir, are you with me?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Sir, are you there?
[CUSTOMER][NEUTRAL] Hello, please, [PII], if you're there still respond.
[CUSTOMER][NEUTRAL] Can I get the claim number?
[CUSTOMER][NEUTRAL] Sorry?