AccountId: 011433970860
ContactId: 700813b3-71b6-46a9-8b5f-70578166ef14
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 546039 ms
Total Talk Time (AGENT): 137236 ms
Total Talk Time (CUSTOMER): 102214 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/700813b3-71b6-46a9-8b5f-70578166ef14_20250228T14:51_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] and I'm calling for the provider to check on additional information about the claim that has been denied. Please note this call will be monitored and recorded for quality and training purposes. Your good name, please?
[AGENT][NEUTRAL] So that's [PII], last initial [PII]. May I have a callback number just in case we get disconnected Mr. [PII]?
[CUSTOMER][NEUTRAL] [PII]. Direct line.
[AGENT][NEUTRAL] Thank you. And you're calling from which facility or provider?
[CUSTOMER][NEUTRAL] And the facility name is going to be just a moment. Augusta Orthopedic Sports Augusta Orthopedic Sports Medicine.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, and may I have a um policy number for the patient, Mister [PII].
[CUSTOMER][NEUTRAL] 02311714.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] NV.
[CUSTOMER][NEUTRAL] Sorry for that. And yeah, the birth, date of birth is [PII]. Is it OK with the name or should I spell it for you?
[AGENT][POSITIVE] No, it's fine. Thank you.
[AGENT][NEUTRAL] And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Member date of service is going to be [PII] and the total charge amount is $6550 even.
[AGENT][NEUTRAL] OK, that's [PII], correct?
[CUSTOMER][POSITIVE] You are right.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] For future you can check claim status online through our website at [PII] and that's just optional.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, let me call this explanation first. Do you mind holding for me?
[CUSTOMER][POSITIVE] OK, sure. Take your time.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding and being patient for me, Mr. [PII]. OK, it looks like we processed the claim on [PII], and we send a benefit amount of $500 which is the maximum for the policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, there's no, so you're stating the claim has been denied for?
[AGENT][NEUTRAL] No, the claim was paid $500 which is the maximum benefit for the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just give me a moment, please.
[AGENT][NEUTRAL] Mhm. Sure.
[CUSTOMER][NEUTRAL] OK. And may I know, is it under the visits value or dollar value?
[AGENT][NEUTRAL] The maximum benefit for that data service and dollar value.
[CUSTOMER][POSITIVE] OK, dollar value.
[CUSTOMER][NEUTRAL] So you're setting per day allowed amount is 5 $500.
[AGENT][NEUTRAL] OK. On this one, OK, this particular policy is the hospital indemnity policy, which it covers 1 day per cover person per calendar year and $500 is the maximum.
[AGENT][NEUTRAL] So basically the calendar year max and the daily max has been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just a moment. And also, could you please provide me when was the last time it was used? I mean, maximum benefits has been exhausted.
[AGENT][NEUTRAL] Yeah sure.
[AGENT][NEUTRAL] Your payment
[CUSTOMER][NEUTRAL] OK. Could you please provide me the claim number?
[AGENT][NEUTRAL] Yes, it's 356-1799.
[CUSTOMER][NEUTRAL] May I know the received date?
[AGENT][NEUTRAL] OK, let me get that because that's not on the ELB one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was received on [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it was [PII], right?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][POSITIVE] Thank you so much. And also, could you please provide me the
[CUSTOMER][NEUTRAL] Apple mailing address?
[AGENT][NEUTRAL] Sure, that is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you so much. Could you please provide me the call reference number, sir?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in the state if you will, Mr. [PII].
[CUSTOMER][POSITIVE] Thank you so much and have a great day. Bye-bye.
[AGENT][POSITIVE] You as well and thank you for calling ATO Mr. [PII]. Bye-bye.
[CUSTOMER][POSITIVE] Happy weekend.