AccountId: 011433970860
ContactId: 5df92294-5a66-4a1b-9ab9-9e4336b40a79
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 341559 ms
Total Talk Time (AGENT): 85619 ms
Total Talk Time (CUSTOMER): 108279 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/5df92294-5a66-4a1b-9ab9-9e4336b40a79_20250224T19:32_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Uh, no, I'm calling from provider's office.
[AGENT][NEUTRAL] OK, may I have your first name please?
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][POSITIVE] And if I can get a good call back number for you?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Patient's policy number is gonna be 246-0355.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] Date of birth? [PII].
[AGENT][NEUTRAL] And what is the date of service for the claim?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And your tax ID?
[CUSTOMER][NEUTRAL] Give me a moment, please. I'll let you know.
[CUSTOMER][NEUTRAL] Tax ID [PII]?
[AGENT][NEUTRAL] Thank you for that information. I do show that the claim was denied because their outpatient maximum have been met for the year.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Was there anything else I could assist with today?
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] It's maximum, uh, you mean patient already met maximum amount, met amount, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Uh, OK. Can you please tell me, uh, what is the met one?
[AGENT][NEUTRAL] Um, it looks like for outpatient.
[AGENT][NEUTRAL] The calendar year maximum is $3500 and that was already paid out prior to receiving this claim.
[CUSTOMER][NEUTRAL] Yes, that's annual amount. But what is the patient met amount?
[AGENT][NEGATIVE] I don't understand the question.
[CUSTOMER][NEUTRAL] Um, you said patients met amount or annual amount?
[CUSTOMER][NEUTRAL] Patient's annual amount.
[AGENT][NEUTRAL] $3500.
[CUSTOMER][NEUTRAL] That's the annual amount, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, then what is the patient my amount?
[AGENT][NEGATIVE] What do you mean net amount? I don't understand what you're asking me. I'm sorry.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Met amounts means uh the amount uh which is met by patient and
[CUSTOMER][NEUTRAL] Annual amount means uh the amount uh which is fixed to a year, right? That amount.
[AGENT][NEGATIVE] We don't have a met amount we they have a maximum yearly benefit that we pay and once we've paid that much out we stop paying.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] So, maximum amount is uh $3500 right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Uh, what is the claim received date?
[AGENT][NEUTRAL] Claim was received on [PII], claim denied on [PII].
[CUSTOMER][POSITIVE] Thanks
[CUSTOMER][NEUTRAL] OK. Uh, I don't have UOB, uh, so can you please fax to the UOB?
[AGENT][NEUTRAL] OK, and what is that fax number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] To whose attention?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Uh, can you please spell your name for me?
[AGENT][NEUTRAL] [PII], last initial is [PII], and you should receive that fax by the close of business today. Was there anything else I could assist with today?
[CUSTOMER][NEUTRAL] 4 business days, right?
[AGENT][NEUTRAL] The close of business.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, OK, I'm done for today.
[CUSTOMER][POSITIVE] Thank you. Thanks for assisting today. Uh, what is the claim number?
[AGENT][POSITIVE] Thank you for calling APL.
[AGENT][NEUTRAL] Claim number is 3552289.
[CUSTOMER][NEUTRAL] 3552289, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Uh, what is the policy number?
[AGENT][NEUTRAL] Reference is just my name and today's date and time.
[CUSTOMER][POSITIVE] OK. Thank you, [PII]. Thanks for asking today. Have a nice day. Bye-bye.
[AGENT][POSITIVE] Thank you for calling APO have a good day.