AccountId: 011433970860
ContactId: 65086d90-ff5a-4efc-9b4b-d53d0a245821
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 522400 ms
Total Talk Time (AGENT): 118796 ms
Total Talk Time (CUSTOMER): 148664 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/65086d90-ff5a-4efc-9b4b-d53d0a245821_20250521T17:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from the Southern California permanent to check on a claim status.
[AGENT][NEUTRAL] OK, I can help you with claim status, [PII]. May I please get your callback number, sir, just in case the call is disconnected?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what is uh the name of the patient, the date of birth, and policy number?
[CUSTOMER][NEUTRAL] Mm yes.
[CUSTOMER][NEUTRAL] The patient's number ID is [PII]. Patient's name is [PII]. I'm sorry, [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] OK, let me pull up that policy real quick for us.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and then may I have the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Its data services on [PII] bill amount is $365.
[AGENT][NEUTRAL] OK, and what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Southern California.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold, [PII], while I look at this claim for us and I'll be right back sir.
[CUSTOMER][POSITIVE] Sure, take your time.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Wow
[AGENT][NEUTRAL] Thank you for holding for me, [PII]. I have the claim information for you. The claim number is 359-523-8.
[AGENT][NEUTRAL] And the claim has been denied because the calendar maximum for emergency room has been met.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] What is allowable maximum maximum unit for the patient?
[AGENT][NEUTRAL] Let, let me look for emergency room.
[CUSTOMER][NEUTRAL] Hi.
[AGENT][POSITIVE] They get 2 visits per year and he has met his maximum.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] When was the last date?
[AGENT][NEUTRAL] I can't give that information out.
[CUSTOMER][NEUTRAL] for uh for documentation we need that information.
[CUSTOMER][NEUTRAL] Previously when these two visits were met by the patient.
[AGENT][NEUTRAL] I can't give that information out, sir.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Cause this is a IPA I.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Is it what, sir?
[CUSTOMER][NEGATIVE] You won't provide because this was uh EPA Airlines.
[AGENT][NEUTRAL] Right, it may not be your facility, so I cannot give out that information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's see
[CUSTOMER][NEUTRAL] Mm OK.
[CUSTOMER][NEUTRAL] Just a moment please.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] Let me check just one information.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] One.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, thank you. And I do have one more data of service for the same patient. Could you please help me with that?
[AGENT][NEUTRAL] Absolutely. What is the data service?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Yes, it is uh [PII]. The amount is $365.
[AGENT][NEUTRAL] OK, and is it and it's for the same facility, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold. I'm gonna look this one up and I'll be right back.
[CUSTOMER][NEUTRAL] OK. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you [PII] for holding for me. I've got this information for you. The claim number is 359-523-9, and the claim was denied for the same reason calendar year maximum for ER visits has been met.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, um, for that booth also it was, uh, allowed to.
[AGENT][NEUTRAL] Yes, 2 per year.
[CUSTOMER][NEUTRAL] To it was allowed to write it, yeah.
[CUSTOMER][NEUTRAL] Um, you can you, um, provide just the dates like when it was met previously?
[AGENT][NEUTRAL] No, sir.
[AGENT][NEUTRAL] I can, I cannot give any information.
[CUSTOMER][NEUTRAL] OK, fine. Thank you. Could you please spell your name?
[AGENT][NEUTRAL] Yes, it's [PII]
[CUSTOMER][NEUTRAL] Thank you. May I know the call reference number, 30?
[AGENT][NEUTRAL] Yes, you can use my name and today's date.
[CUSTOMER][POSITIVE] That's it for me and you have a nice day bye for now.
[AGENT][POSITIVE] You have a wonderful day too, and thank you for calling APL. You take care, [PII]. Bye bye.
[CUSTOMER][POSITIVE] Yes you too bye.