AccountId: 011433970860
ContactId: 6cdeaa78-ed13-4ae6-86f7-54390eb9a929
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 190669 ms
Total Talk Time (AGENT): 86698 ms
Total Talk Time (CUSTOMER): 56029 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/2025/02/25/6cdeaa78-ed13-4ae6-86f7-54390eb9a929_20250225T21:09_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I'm looking to see if I could get.
[CUSTOMER][NEUTRAL] I mean I need to know if you have a claim on file.
[AGENT][NEUTRAL] Um, yes, ma'am. I can assist you with claim status. Um, first, could I get your name and a good callback number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, [PII]. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] 02.
[CUSTOMER][NEUTRAL] 425331.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII] [PII].
[AGENT][NEUTRAL] Thank you and now I need the date of service and bill charges on the claim.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] The total bill charges 1,299.
[AGENT][NEUTRAL] OK, yes, ma'am. We did receive that claim. We received it on [PII]. The claim was processed on [PII], and this claim denied because the benefit maximum was reached on a previous claim.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So what's the patient's responsibility?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Whatever the bill charges are, whatever went towards the copay, the co-insurance or deductible. See, under this policy, we cover up to 500 per occurrence and um that was met on a previous claim.
[CUSTOMER][NEUTRAL] And the what was meant?
[AGENT][NEUTRAL] The benefit maximum was met. It was reached on a previously submitted claim. She maxed out the $500. Yes, ma'am.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Um, yeah, you guys are secondary to Aetna and Aetna process to the deductible.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And and you guys are the secondary and you said that they've reached their maximum benefit.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] Can I get a reference number?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date. My name is [PII], um it's spelled [PII] and my last initial is [PII] and today's date. Is there anything else that I can assist you with? Do you need the claim number?
[CUSTOMER][POSITIVE] Uh yes please.
[AGENT][NEUTRAL] OK. The claim number is
[AGENT][NEUTRAL] 356-623-2.
[CUSTOMER][POSITIVE] OK great thank you so much.
[AGENT][NEUTRAL] OK. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Uh, no, that's it.
[AGENT][POSITIVE] OK, well I thank you again, [PII] for calling ATL. You have a great day. Bye.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Mhm. Thanks.