AccountId: 011433970860
ContactId: 6b7e70f1-813c-471c-8eba-b9735f84135a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 314589 ms
Total Talk Time (AGENT): 95321 ms
Total Talk Time (CUSTOMER): 98121 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/6b7e70f1-813c-471c-8eba-b9735f84135a_20250624T14:07_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Hi, I'm [PII] calling from the provider's office to check on a claim status.
[AGENT][NEUTRAL] OK, I can verify claim status for you, [PII]. And what is the policy number, please?
[CUSTOMER][NEUTRAL] It is 025.
[CUSTOMER][NEUTRAL] 056
[CUSTOMER][NEUTRAL] 08.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Uh yes, ma'am. It is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] The Patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, and what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] Date of service, just a moment.
[CUSTOMER][NEUTRAL] It is uh [PII].
[CUSTOMER][NEUTRAL] Charge amount is $4,389.14.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you please spell your name?
[AGENT][NEUTRAL] Sure. [PII] last [PII] [PII]
[CUSTOMER][NEUTRAL] And the date.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Oh you're welcome. And what's the name of the provider's office?
[CUSTOMER][NEUTRAL] Medical City, Fort Worth Hospital.
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Um, showing the claim process is the maximum benefit for the data service has been met.
[CUSTOMER][NEUTRAL] OK. Could you please provide me the claim received date?
[AGENT][NEUTRAL] Sure, give me one moment.
[AGENT][NEUTRAL] Uh, claim received [PII], processed on [PII].
[CUSTOMER][NEUTRAL] Thank you. And may I know the claim number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 3554874
[AGENT][NEUTRAL] Oh, and I apologize. The claim was received on [PII], processed on.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] I'm sorry, [PII], process on [PII].
[CUSTOMER][NEUTRAL] 0
[CUSTOMER][NEUTRAL] [PII]. OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Thank you so much, ma'am. And the claim maximum benefits existed dollars or visit?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For the dollars for the data service.
[CUSTOMER][NEUTRAL] May I know the total allowed dollars for the member?
[AGENT][NEUTRAL] $50.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] And may I know how much it was made lastly?
[AGENT][NEUTRAL] I'm sorry, if the benefit max is 50 and they've already met their max, so they've met 50.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, is there any information about when it was met lastly?
[AGENT][NEUTRAL] I can't give you that information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know whether it is uh process is in network or out of network?
[AGENT][NEUTRAL] We don't have a network.
[CUSTOMER][NEUTRAL] It is out of network, right?
[AGENT][NEUTRAL] We don't have a network.
[CUSTOMER][NEUTRAL] Uh, no, ma'am. The claim was processed in network or out of network.
[AGENT][NEUTRAL] We don't have a network. It was just process according to their policy with our company. We do not have a network.
[CUSTOMER][NEUTRAL] OK, thank you. Is there any provider discount?
[AGENT][NEUTRAL] We will know we don't have any provider discount we don't reprice claims or reprocess claims since there's no network.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, thank you. May I know the call refreshment book, please?
[AGENT][NEUTRAL] You may use my name at today's date.
[CUSTOMER][POSITIVE] Thank you so much for your assistance. Have a great day thank you.
[AGENT][POSITIVE] Mhm thank you for calling APL bye.