AccountId: 011433970860
ContactId: 609f42a8-5e11-46d7-86b5-2e87b2478a21
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 387000 ms
Total Talk Time (AGENT): 118977 ms
Total Talk Time (CUSTOMER): 180921 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/609f42a8-5e11-46d7-86b5-2e87b2478a21_20250103T16:12_UTC.wav
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[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII] and I would like to know what what claim status.
[AGENT][NEUTRAL] OK, yeah, I can check on the claim for you, [PII]. Uh, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, callback number is [PII].
[AGENT][NEUTRAL] Thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Uh, policy number is
[CUSTOMER][NEUTRAL] 02199643 M Mike Lima 8.
[AGENT][NEUTRAL] OK, thank you. And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh first name is [PII], and last name is [PII] And date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII] uh what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Date of service which is [PII].
[AGENT][NEUTRAL] I'm sorry, that was [PII]?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK, and what was the bill amount, please?
[CUSTOMER][NEUTRAL] But the amount, total amount is $1,725.
[AGENT][NEUTRAL] OK thank you one moment please.
[CUSTOMER][NEUTRAL] 1725.
[AGENT][POSITIVE] Got it, thank you one moment.
[AGENT][NEUTRAL] OK, so we did receive this claim, [PII], uh, we were unable to pay a benefit as the maximum benefit payable for this date of service had been met. There was a previous charge for the same date of service that we had paid.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK. Uh, denied for.
[AGENT][NEUTRAL] They read their they met their maximum benefit uh for the date of service.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Mm, OK. Uh, and claim number?
[AGENT][NEUTRAL] Yes, claim number is 3521553.
[CUSTOMER][NEUTRAL] 553. OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And, uh, claim denied on uh which date.
[AGENT][NEUTRAL] Yes, uh, it was processed [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, I have one more, so please provide the info.
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] Uh, I have one more claim.
[AGENT][NEUTRAL] Is this for the same member?
[CUSTOMER][NEUTRAL] Uh, no, for different number.
[AGENT][NEUTRAL] OK, give me one moment. I'll let you know when I'm ready.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, uh, I'm ready for that next policy number, [PII].
[CUSTOMER][NEUTRAL] Yes, uh, next policy number is 02263436 M Mike Lima 8.
[AGENT][NEUTRAL] OK, thank you. And uh what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Yeah. Uh first name is uh [PII] and last name is [PII] And date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that uh what was the date of service please?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] and then uh the billed out please.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] $146 146.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Mo
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so for this claim, [PII], we were unable to pay a benefit as the outpatient benefit for the calendar year had been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, sorry, uh, repeat that.
[AGENT][POSITIVE] Yes, the outpatient benefits for that calendar year had been met.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] So we were unable to pay a benefit.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm probably.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK. And uh what is claim number?
[AGENT][NEUTRAL] My number is
[CUSTOMER][NEUTRAL] What, uh,
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] But this patient is uh first time for.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] OK, sorry. Uh, please provide the claim number. Sorry.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That's OK. Uh, card number is 349-5942.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh please tell me your name.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, and uh uh call reference number.
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date and so my last initial is [PII], was there anything else I could uh help you with, [PII]?
[CUSTOMER][NEUTRAL] No, thank you for that.
[AGENT][POSITIVE] OK, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye-bye.