AccountId: 011433970860
ContactId: 51c59187-d325-44a3-a9ef-338464de391d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 349709 ms
Total Talk Time (AGENT): 135215 ms
Total Talk Time (CUSTOMER): 132344 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/51c59187-d325-44a3-a9ef-338464de391d_20250217T20:16_UTC.wav
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[AGENT][POSITIVE] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from Bird Health Medical Center. I wanted to get a claim status. Um, would I be able to do that?
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] Yes, ma'am. I can assist you with claim status. Um, first, could I get your name one more time and a good callback number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, I'll spell it for you. [PII]
[AGENT][NEUTRAL] Thank you, [PII]. Um, let's see now I need a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] My direct line is going to be [PII].
[AGENT][NEUTRAL] Thank you, now I need the policy number.
[CUSTOMER][NEUTRAL] Um, 023388-3416004.
[AGENT][NEUTRAL] OK, let me get that number one more time.
[CUSTOMER][NEUTRAL] 023388-3416004
[AGENT][NEUTRAL] OK, that's not one of our policy numbers. It's too many digits. Um, do you have the social or I can look them up by name and date of birth?
[CUSTOMER][NEUTRAL] Hold on, yes, um [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] That means you may have not gotten the.
[CUSTOMER][NEUTRAL] Claim.
[AGENT][NEUTRAL] Let me get that social one more time, please.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what's the date of service and bill charges on the claim, please?
[CUSTOMER][NEUTRAL] [PII] and the bill charges.
[CUSTOMER][NEUTRAL] Um, $23,246.66.
[AGENT][POSITIVE] Thank you, and one moment, please.
[CUSTOMER][POSITIVE] No problem. Do you have the correct um ID number by chance?
[AGENT][NEUTRAL] Um, yes, ma'am. Her policy number is
[AGENT][NEUTRAL] 0233.
[AGENT][NEUTRAL] 883 4.
[CUSTOMER][NEUTRAL] 02, I'm sorry, 0233.
[AGENT][NEUTRAL] 883 4.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] So it's without the ending. Oh man, why did they put the ending?
[AGENT][NEUTRAL] OK, and again you said for the claim the date of service was [PII] and bill charges $23,246.66.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK. Yes, we received that claim on.
[AGENT][NEUTRAL] We received it on [PII] and it processed and paid out on [PII].
[AGENT][NEUTRAL] Um, it paid out for $3520 even.
[AGENT][NEUTRAL] I'm sorry, no, I paid out for $3250 even.
[AGENT][NEUTRAL] And it paid out that amount because the outpatient benefit maximum um was reached for the calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Received
[CUSTOMER][NEUTRAL] What, what, what day was it received? I'm sorry.
[AGENT][NEUTRAL] And we received it on.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And it paid 3250.
[CUSTOMER][NEUTRAL] 83,250 because you said out.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] The outpatient benefit maximum was reached.
[CUSTOMER][NEUTRAL] Patient.
[CUSTOMER][NEUTRAL] Benefit.
[CUSTOMER][NEUTRAL] Max reached.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, because we did resend it, but it's the outpatient, that means it wouldn't pay anymore, correct?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And is this a supplemental or health insurance for the patient?
[AGENT][NEUTRAL] Yes, a supplemental health insurance plan.
[CUSTOMER][NEUTRAL] It's a supplemental portion of her.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Can I have um your name again and the reference number please?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date. My name is [PII]. It's spelled [PII] My last initial is [PII] and today's date. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Um, can I get a copy of the ELB sent, please?
[AGENT][NEUTRAL] Um, yes. What's your fax number?
[CUSTOMER][NEUTRAL] 9 it's going to be attention and then the account number is [PII].
[CUSTOMER][NEUTRAL] And the fax number, let me know when you're ready.
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, so that's extension [PII] and the number is [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK. You should receive it in about 10 minutes. I just sent it. Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] That's all. Thank you so much.
[AGENT][POSITIVE] OK. Thank you, [PII] for calling ATL. You have a great rest of your day. Mm bye.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][NEUTRAL] Mhm.