AccountId: 011433970860
ContactId: 5ad42e11-1644-4cc6-a9fe-875444327b81
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 177699 ms
Total Talk Time (AGENT): 91478 ms
Total Talk Time (CUSTOMER): 59152 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/5ad42e11-1644-4cc6-a9fe-875444327b81_20250521T13:39_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from Orlando Health Hospital. I'm just trying to get some more clarification on a claim, um, that's been processed.
[AGENT][NEUTRAL] OK, [PII], I'm happy to check a claim. Do you have the policy number, claim number?
[CUSTOMER][NEUTRAL] Um, I have both. Which, which one is easier for you to find?
[AGENT][NEUTRAL] You know, honestly, if you have the claim number, I can pull what I need from that if you want to give that to me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, so I have 354.
[CUSTOMER][NEUTRAL] 7581. Excuse me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then if I could just get the insured's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yes, I have uh [PII], uh, date of birth, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, OK. So.
[AGENT][NEUTRAL] Looks like it was data service 9124.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it looks like it's showing denied the outpatient benefit for the calendar year had already been met.
[AGENT][NEUTRAL] So let me see what their benefits are on this.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So their outpatient max was 1250 and it looks like that had already been met. So there was, that's why there was nothing paid on this.
[CUSTOMER][NEUTRAL] OK. Um, it looks, um, so United Healthcare process as primary. Um, is, is there, is, is there an option to, to appeal or this member, um, has maxed out for
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's for the year? It's OK.
[AGENT][NEUTRAL] Yes, yes, so we're their secondary and uh for [PII], the calendar year max had already been a lot had already been used, so there was nothing additional. It can be appealed within 180 days. Um, the claim was processed back in January on the [PII], so maybe too far gone or too late at this point.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK. And um I think
[CUSTOMER][NEUTRAL] Yeah, I am.
[CUSTOMER][NEUTRAL] Yeah, it's gonna be OK, thank you for that information. Um, if I could just have a reference number for the call, thank you for looking into that.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No, not a problem. Call reference is gonna be my name with my last initial in today's date. My name again is [PII], that's [PII] and then the last initial to my name is gonna be [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][NEUTRAL] Bye