AccountId: 011433970860
ContactId: 657933a6-5c62-4bcb-a527-89335c4ccfc9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 338299 ms
Total Talk Time (AGENT): 134544 ms
Total Talk Time (CUSTOMER): 89135 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/657933a6-5c62-4bcb-a527-89335c4ccfc9_20250226T15:46_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yeah, can you, can you please spell your name for me?
[AGENT][NEUTRAL] Sure, [PII], last initial [PII]
[CUSTOMER][NEUTRAL] So, what is the issue?
[AGENT][NEUTRAL] Last initial [PII]. And your name is?
[CUSTOMER][POSITIVE] Yeah, thank you so much.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, I'm sorry. I can barely hear you. Say again.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and how may I assist you today?
[CUSTOMER][NEUTRAL] Yeah, this call is regarding the claim status. Can you please help me with that?
[AGENT][NEUTRAL] Sure, I can verify claim status for you. And how do you pronounce your name [PII]?
[CUSTOMER][NEUTRAL] Right, right.
[AGENT][NEUTRAL] OK, and what is that policy number, please?
[CUSTOMER][NEUTRAL] It would be 01940423.
[AGENT][NEUTRAL] You said 0423?
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] So, [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Yeah. So the last name would be [PII] and the first name would be [PII]
[CUSTOMER][NEUTRAL] And the date of birth was on
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And what is, what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the amount of the charge?
[CUSTOMER][NEUTRAL] The total
[CUSTOMER][NEUTRAL] $3740.21.
[AGENT][NEUTRAL] OK, thank you. And to uh to to [PII], do you have the balance after primary has processed the claim?
[CUSTOMER][NEUTRAL] Just a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. And you're calling from?
[CUSTOMER][NEUTRAL] Provider's office. I don't have Palm Coast Parkway.
[AGENT][NEUTRAL] What's the name of the provider, sir?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't have
[AGENT][NEUTRAL] OK, and while I'm looking up claim information, just to let you know we do have an online service center where providers can check claim status as well as print out the EOB. That site is at [PII].
[AGENT][NEUTRAL] And I show this claim process as. Give me a moment.
[AGENT][NEUTRAL] The maximum amount payable for this occurrence has been met.
[CUSTOMER][NEUTRAL] So you're saying that
[CUSTOMER][NEUTRAL] Maximum amount payable for the so and so.
[AGENT][NEUTRAL] I'm saying
[AGENT][POSITIVE] Correct. The insurer has met their benefit for this occurrence.
[CUSTOMER][NEUTRAL] So how many currents can be built on the day?
[AGENT][NEUTRAL] I'm sorry, say again.
[CUSTOMER][NEUTRAL] How many units was built?
[CUSTOMER][NEUTRAL] In one day.
[AGENT][NEUTRAL] It's not units, it's dollar value with this insurance policy for outpatient, they have a benefit that pays per occurrence. So for that occurrence it's already been met.
[CUSTOMER][NEUTRAL] What's the dollar amount for that?
[AGENT][NEUTRAL] Uh, the insured had a benefit amount up to $250 per occurrence.
[CUSTOMER][NEUTRAL] OK. When it was uh previously paid?
[AGENT][NEUTRAL] Right
[AGENT][POSITIVE] Yes, they have met the benefit max for this occurrence.
[CUSTOMER][NEUTRAL] OK, when it was, when it was me.
[AGENT][NEUTRAL] I can't give you that information.
[CUSTOMER][NEUTRAL] What's the reason because we need the details for our documentation.
[AGENT][NEUTRAL] I'm
[AGENT][NEGATIVE] I'm not understanding. Say again.
[CUSTOMER][NEUTRAL] We need that information.
[AGENT][NEUTRAL] Well, I can't give that information to you. If it's not in relation to a claim you're inquiring about, I cannot give you that information.
[CUSTOMER][NEUTRAL] Is it for the same provider?
[AGENT][NEUTRAL] I can give that information. I can't give you any information in regards to another claim that's been processed. They have met their max for this occurrence.
[CUSTOMER][NEUTRAL] Is it for the same provider?
[AGENT][NEUTRAL] I cannot give you that information.
[CUSTOMER][NEUTRAL] But for the previous representative has been giving me the details regarding that.
[AGENT][NEUTRAL] Well, I cannot give you that information, sir. Is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] And this is a follow-up plan.
[CUSTOMER][POSITIVE] No, thank you so much.
[AGENT][POSITIVE] OK, uh thanks for calling APL. You have a great rest of your day.
[CUSTOMER][NEUTRAL] Yeah.