AccountId: 011433970860
ContactId: 6695bad4-2ce7-4025-8796-10d7d3cba3c0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 631580 ms
Total Talk Time (AGENT): 121858 ms
Total Talk Time (CUSTOMER): 156092 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/6695bad4-2ce7-4025-8796-10d7d3cba3c0_20250320T14:55_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]. This is [PII] calling from Bo's office. I need to check a claim status.
[AGENT][NEUTRAL] OK, I mean, I can help you with claim status. Can you please give me your callback number just in case the call gets disconnected?
[CUSTOMER][NEUTRAL] Sure. It's [PII]. It's a direct line with the extension.
[AGENT][NEUTRAL] OK, thank you. And then what's the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yeah, of course, the patient name would be
[CUSTOMER][NEUTRAL] Uh, [PII], and the date of birth would be [PII]. And the date of service is [PII] with the total charge amount of $2,492 even.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, and what's the uh patient's policy number?
[CUSTOMER][NEUTRAL] This way
[CUSTOMER][NEUTRAL] Patient policy number. OK, one moment. The policy number would be 024.
[CUSTOMER][NEUTRAL] 92,690
[AGENT][NEUTRAL] OK, let me look up that policy real quick.
[AGENT][NEUTRAL] OK, and you said that uh charge amount is $2,04.92?
[CUSTOMER][NEUTRAL] No, no. I said $2,492 even.
[AGENT][NEUTRAL] 0, 492 even OK.
[AGENT][NEUTRAL] Alright, and what's the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] The name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Uh, one moment. The name of the facility would be Saint Joseph Registered Medical Center.
[AGENT][NEUTRAL] OK, on a brief hold while I look up this claim and I will right back I mean.
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][POSITIVE] Thanks
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh, a lot of noise.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thanks for holding I mean, so that I've got the claim. The claim number is 33562054.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And the was denied because the patient's benefits had maxed out for the calendar year.
[CUSTOMER][NEUTRAL] As I say
[CUSTOMER][NEUTRAL] The patient benefit has maxed out, right?
[AGENT][NEGATIVE] Yeah, maxed out exhausted.
[CUSTOMER][NEUTRAL] OK, for the calendar year. So how, uh, may I know, uh, in terms of in terms of dollars or is that, um, claims got where exit.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] A dollar amount.
[CUSTOMER][NEUTRAL] It was $1 amount, sorry?
[AGENT][NEUTRAL] And they used all their, all the dollar, yeah, and it goes by dollar amount and they used up all their benefits, yes.
[CUSTOMER][NEUTRAL] Dollar amount. OK. So,
[CUSTOMER][NEUTRAL] OK, so how much is the dollar amount per year?
[AGENT][NEUTRAL] Let me look.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] They get 2 visits per calendar year.
[AGENT][NEUTRAL] At $50.
[CUSTOMER][NEUTRAL] To visit and per visit, it is $50 right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And they have exit both, and they have exit both, right?
[AGENT][POSITIVE] Yes, they use them.
[CUSTOMER][NEUTRAL] OK. I just want to confirm one more thing. Is it included in this, uh, with this account or uh excluding this account?
[AGENT][NEUTRAL] I'm sorry, can you repeat that question?
[CUSTOMER][NEUTRAL] Yeah. You said the max of 2 visit has been exceeded, including this uh visit or uh uh excluding this visit?
[AGENT][NEUTRAL] Excluding, it was before this visit.
[CUSTOMER][NEUTRAL] OK. Before this it was already taken. OK, got it. OK. Uh, for the second phone, still you have not received the UOB for this. Could you please fax us the UOB?
[AGENT][NEUTRAL] Yes, can you please give me your fax number?
[CUSTOMER][NEUTRAL] Yeah, the fax number will be [PII].
[CUSTOMER][NEUTRAL] Again, it's [PII].
[AGENT][POSITIVE] Thank you and I mean can you spell your name for me so I make sure I spell it right?
[CUSTOMER][NEUTRAL] Yeah, of course. It's [PII], and initial last name is [PII].
[AGENT][POSITIVE] OK, thank you so much and I'm gonna put you on a brief hold again while I get this fax sent over to you I'll be right back.
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding I mean I have that on its way to you now.
[CUSTOMER][NEUTRAL] OK. So how long it will take to to receive the UOB?
[AGENT][NEUTRAL] Uh, it's been sent. You just have to give it a chance to get there.
[CUSTOMER][NEUTRAL] OK, got it. May I finish the last name, [PII]?
[AGENT][NEUTRAL] It's A
[CUSTOMER][NEUTRAL] [PII]. OK. I just want to double check whether the received date and the denied date would be the received date is [PII] and the denied date will be [PII]. Is that correct?
[AGENT][NEUTRAL] Let me check real quick.
[CUSTOMER][NEUTRAL] It
[AGENT][POSITIVE] Yes, you are correct.
[CUSTOMER][POSITIVE] OK, got it. Thank you so much for your wonderful assistance. May I have the call reference number?
[AGENT][NEUTRAL] Yes, you can use my name [PII] and today's date.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Got it. Thank you so much for your wonderful assistance. Have a nice day.
[AGENT][POSITIVE] You too I mean you have a good one thank you for calling APL.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Bye for now.
[AGENT][NEUTRAL] Bye-bye.