AccountId: 011433970860
ContactId: 4f5773bf-02f4-46f2-b7d4-0b489eb5df51
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 258660 ms
Total Talk Time (AGENT): 116610 ms
Total Talk Time (CUSTOMER): 78171 ms
Interruptions: 3
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/4f5773bf-02f4-46f2-b7d4-0b489eb5df51_20250204T16:18_UTC.wav
--------------------------------------------
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Can you hear me?
[CUSTOMER][NEUTRAL] Yes, I can hear you now.
[AGENT][POSITIVE] OK, uh, sorry about that. um, this is [PII]. How can we help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I'm giving you a call in regards, would you be able to help me on a claim?
[AGENT][NEUTRAL] Of course, yeah, I can check on the time for you. Yeah, let's see, we're just needing to check on the status, is that correct?
[CUSTOMER][NEUTRAL] A medical claim?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, it said that it denied that the patient benefits um max for this data service, so I just need a little bit more detailed information on what does that mean.
[AGENT][NEUTRAL] OK. Sure.
[AGENT][POSITIVE] Absolutely. OK, we can take a look at that. um [PII] first if you don't mind, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, my direct line is [PII].
[AGENT][NEUTRAL] All right, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, the patient ID number is [PII].
[AGENT][NEUTRAL] And uh what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Um, [PII]. Date of birth is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. So I, and I'm sorry, you did say that it was [PII]?
[CUSTOMER][NEUTRAL] 645-556, is it? Hold on, let me, is it more numbers?
[AGENT][NEGATIVE] OK. I did not get any results with that. Yes, there should be some more digits in there. Mhm.
[CUSTOMER][NEUTRAL] OK, let me look at this EOP. OK, let me look at this EOP.
[AGENT][NEUTRAL] If it's easier on the EOB, um, if you see the claim number I can search that way too.
[CUSTOMER][NEUTRAL] Oh, I have the policy number or the claim number which one do you prefer?
[AGENT][POSITIVE] Um, you could just give me that policy number first, that'd be great.
[CUSTOMER][NEUTRAL] OK, it's 024.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 98843.
[AGENT][NEUTRAL] I'm sorry, that was 98843?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 024.
[AGENT][POSITIVE] Got it thank you one moment.
[AGENT][NEUTRAL] Alrighty there we are OK um then of course you did verify that information appreciate that and then I can go ahead and take that claim number please.
[CUSTOMER][NEUTRAL] OK, the claim number is 3540038.
[AGENT][POSITIVE] Got it thank you one moment.
[AGENT][NEUTRAL] That was the emergency physicians?
[CUSTOMER][NEUTRAL] Yes, Lagrange.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, yes. Benefit maximum for the state of service has been met. Let me take a look at the benefits. So this plan is a limited indemnity medical plan. So it does operate a bit differently. Yeah. Give me just a moment, let me see what that amount was.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] OK, so yes, it's gonna go per date of service, um, and they had already exhausted that prior that was uh $75 was that maximum benefit amount and there was another claim before this one that we paid that amount on.
[CUSTOMER][NEUTRAL] OK, so they have a limited indemnity plan.
[AGENT][NEUTRAL] Right, limited indemnity medical plan, yes.
[CUSTOMER][NEUTRAL] Medical plan
[CUSTOMER][NEUTRAL] OK, so that's why it says that. OK, so this is definitely patients responsibility. OK, and what did you say your name was? I didn't catch you in the beginning because I don't know if the phone went out.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Oh sorry, no, yeah, I don't know what happened either. Um, it's [PII]
[CUSTOMER][NEUTRAL] No, you're fine.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Is there a reference number, [PII]?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Uh, so my last initial is [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][POSITIVE] That's it. I really appreciate your help and have a wonderful day.
[AGENT][POSITIVE] All right. Yes, ma'am. You too. Thank you. Bye bye.