AccountId: 011433970860
ContactId: 6dd46f1a-1415-4fc7-b05e-11b5495e4d6d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 592359 ms
Total Talk Time (AGENT): 174880 ms
Total Talk Time (CUSTOMER): 190518 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/6dd46f1a-1415-4fc7-b05e-11b5495e4d6d_20250618T22:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. This is [PII] calling from provider's office to check the claim status.
[AGENT][NEUTRAL] OK, I can check on a claim for you. [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII].
[AGENT][NEUTRAL] OK, thank you. And do you have that policy number?
[CUSTOMER][NEUTRAL] Uh, yeah, sure. Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sure, it is.
[CUSTOMER][NEUTRAL] D like Delta 43732467.
[AGENT][NEUTRAL] OK, so [PII], that's not one of our policy numbers that is through, uh, they're called 90 degree benefits. If you'd like, I can transfer you to them and give you their information, uh, or if you have the member's social, I could see if they have a policy with us.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, also, can you search the name and date of birth, or we need to reach the 90 degree.
[AGENT][NEUTRAL] Um, I could try searching with their name. I wouldn't be able to use the date of birth. Would you mind spelling out the first and last name for me?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm sure.
[CUSTOMER][NEUTRAL] First name is [PII]. It's [PII] and last name is [PII]. It's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK and then do you have this member's uh date of birth?
[CUSTOMER][NEUTRAL] Mm yes, sure.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. And was this for uh medical?
[CUSTOMER][NEUTRAL] Yeah, medical, yeah.
[AGENT][NEUTRAL] OK, got it. I was able to locate that policy. What was the date of service for this claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, it's [PII] for $312 even.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That was [PII] for $312.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] OK all right thank you one moment.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Uh, [PII], I'm sorry, what was the, um, tax ID for this provider, please?
[CUSTOMER][NEUTRAL] Uh, yes, it's [PII].
[AGENT][NEUTRAL] OK, and then that $312 was that the amount before or after major medical paid?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] No, I couldn't get that.
[AGENT][NEUTRAL] Oh, I'm sorry, it's just supposed to be 312 even correct?
[CUSTOMER][NEUTRAL] Mm, yes, yeah.
[AGENT][NEUTRAL] OK, OK, I apologize for the confusion right, one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's just
[AGENT][NEUTRAL] OK, I am not showing that we've received a claim for that amount for this uh date of service.
[CUSTOMER][NEUTRAL] Yeah, sure. So this claim was denied, right, for maximum benefits met.
[AGENT][NEUTRAL] Um, no, I'm, I'm not able to see this claim. I, I'm not showing that we have received a claim for this amount.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, or else, can you search the claim number?
[AGENT][NEUTRAL] If you have that claim number, yes please.
[CUSTOMER][NEUTRAL] Uh, yes, OK. It is 355-5963.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, I apologize. I don't know why I couldn't find that. Uh, give me just a moment, let me check that denial reason.
[AGENT][NEUTRAL] OK, yes, um, so yes, we were unable to pay a benefit as the calendar year maximum on diagnostic services has been met.
[CUSTOMER][NEUTRAL] Mm, sure, sure. OK.
[CUSTOMER][NEUTRAL] OK. And may I know what is the maximum amount?
[AGENT][NEUTRAL] Uh yes one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh
[AGENT][POSITIVE] Bear with me just a moment. I appreciate your patience just getting that information pulled up.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, so I did locate that, uh, diagnostic testing benefit that amount is $250 and that is uh per calendar year. That is the maximum benefit amount.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So, $250 per calendar here, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] But since this state of service, it's on [PII], I do see that it's just the beginning of this year. And also, mhm.
[AGENT][NEUTRAL] Right, I can check to see when that was if there was another, give me just a moment, let me take a look at that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] OK, yes, it looks like it was for the same date of service um I do see two diagnostic tests, uh, that were filed, uh, prior to, um, this one for the same date of service, uh, let's see, one of them was from this provider that was for $172. I can give you that claim information if you need that. The other one is from a different provider, so I'm unable to disclose that information.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm, that's fine. I have that information.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's for $17237 right?
[AGENT][NEUTRAL] Uh let's see. Yes, yes, that was that same claim.
[CUSTOMER][NEGATIVE] Mm, so both of them were paid. So based on that, the benefits were exhausted and this one was denied, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] It's just for every calendar year from [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Mm, just thanks for that. And may I know your first name, please?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][POSITIVE] Yeah, thanks, sir, and just give me a minute, [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is that OK?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][POSITIVE] Yeah, thanks for that, yeah. So that's it finally, can I get the call reference number please?
[AGENT][NEUTRAL] Sure, reference number would just be my first name, last initial, and today's date. Uh, so my last initial is A, although there wasn't anything else I could help you with?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Mm, that's it, [PII]. Thank you so much for that.
[AGENT][POSITIVE] Alright, yeah, thanks for calling HL. I hope you have a great rest of your day. Thank you. Bye bye.
[CUSTOMER][POSITIVE] Yeah. Have a great day. Yeah.
[CUSTOMER][NEUTRAL] Mm yes. bye-bye.