AccountId: 011433970860
ContactId: 538152cd-a9a9-4e69-86b2-d2e088183a36
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 350019 ms
Total Talk Time (AGENT): 168587 ms
Total Talk Time (CUSTOMER): 100727 ms
Interruptions: 3
Overall Sentiment: AGENT=0.8, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/538152cd-a9a9-4e69-86b2-d2e088183a36_20250409T13:05_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Oh here we go.
[CUSTOMER][NEUTRAL] 2 seconds.
[CUSTOMER][NEUTRAL] Hey [PII], [PII]'s had her own [PII]. How you doing?
[AGENT][POSITIVE] Hi, [PII], I'm good. How are you today?
[CUSTOMER][POSITIVE] Doing great doing great just wanted to double check one thing with you on a claim if you don't mind for one of our customers.
[AGENT][NEUTRAL] OK, you're wanting to check on a claim status fine, is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, thank you and the member's policy number please, [PII].
[CUSTOMER][NEUTRAL] Um, member's policy number is 2331723.
[AGENT][NEUTRAL] OK, thank you. Give me just a moment to get that pulled up.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and [PII], as you know, any information provided would be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, [PII] and uh it's [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] OK, thank you and the group that she worked for?
[CUSTOMER][NEUTRAL] Um, she works for Kent Design Build.
[AGENT][NEUTRAL] OK, thank you and then your email, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you so much. So one moment.
[AGENT][NEUTRAL] And what is the data service, [PII], and total bill?
[CUSTOMER][NEUTRAL] In the claim
[CUSTOMER][NEGATIVE] It it's um I know we received them back instead.
[AGENT][NEUTRAL] for her?
[CUSTOMER][NEUTRAL] I know we received them back in [PII] and, and they were processed. I'm just trying to see what was processed on there.
[CUSTOMER][NEUTRAL] I think the claims ended in 776 and 409.
[AGENT][NEUTRAL] OK, so on
[AGENT][NEUTRAL] Uh, for the one, let's see, right, so this is for data service 817.
[AGENT][NEUTRAL] So, OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] One
[AGENT][NEUTRAL] OK, so on the ending in 09.
[AGENT][NEUTRAL] That benefit pay 20.
[AGENT][NEUTRAL] $1700 even.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so how you doing? Good morning. OK, so, um, I apologize. I have some people coming in, so 2700 and
[AGENT][NEUTRAL] OK. And
[AGENT][NEUTRAL] Oh, that's
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And that was for the admission and daily benefit?
[AGENT][NEUTRAL] And let me look
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yes, she was.
[CUSTOMER][NEUTRAL] Yeah there should be something.
[AGENT][NEUTRAL] There was a surgery and a hospital benefit, and yes, and a hospital confinement benefit, admission and confinement benefit for that one.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And let's see.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] Oh, just one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The wrong thing. OK. And so that, yes, that benefit was issued. Now let me look at the most recent the other one.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Now, on the other one ending in 76, claim was denied.
[AGENT][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see what the reason was for that one, and I do apologize if you heard me coughing, [PII]. I couldn't put you on mute quick enough.
[CUSTOMER][POSITIVE] No worries.
[CUSTOMER][POSITIVE] No worries.
[AGENT][NEUTRAL] This pollen in [PII] is about to take me out.
[CUSTOMER][NEUTRAL] I understand. I'm with you. I have the same thing.
[AGENT][NEGATIVE] Even, even with Zyrtec, it's like it doesn't care. It just doesn't care.
[AGENT][NEUTRAL] OK, so it states on this 11 of the remarks was the calendar, your maximum for this benefit has been exhausted and there are no additional benefits payable, um, one of them shows it was a duplicate of previously submitted expenses.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Benefit Max, the next remark is the benefit max for this data services been that another duplicate.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Fine item the calendar max for this benefit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, yes, on that one, it was either the calendar Max, the benefit Max, yeah, was met.
[CUSTOMER][NEUTRAL] So it sounds like she got.
[CUSTOMER][NEUTRAL] OK, so it sounds like she got the surgery, hospital admission and hospital confinement, but she didn't receive any of the urgent care benefits because I think she went to urgent care once or twice, um, so if she did, she needs to submit separate, um, paperwork for that, right?
[AGENT][NEUTRAL] Uh,
[AGENT][POSITIVE] Correct, yes, because we do not have that. Yes, OK, [PII], well, if that's all I can help you with, thank you for calling APL and I hope that you have a wonderful day.
[CUSTOMER][NEUTRAL] Got it, that's all I need to know.
[CUSTOMER][POSITIVE] Thanks so much. Have a good day.
[CUSTOMER][POSITIVE] Thanks so much. Have a great day. Thanks. Thank you. Bye-bye.
[AGENT][POSITIVE] All right. You too. Thank you. Bye-bye.
[AGENT][NEUTRAL] You too, [PII].