AccountId: 011433970860
ContactId: 79dbe840-d36f-493f-a21d-9099ca5b71ee
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1824439 ms
Total Talk Time (AGENT): 747960 ms
Total Talk Time (CUSTOMER): 490641 ms
Interruptions: 10
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/79dbe840-d36f-493f-a21d-9099ca5b71ee_20250106T20:49_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Oh, hi, [PII]. This is [PII] calling from provider's office to check on claim status.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the claim status, [PII]. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Uh, for the same patient, I do have 10 data services.
[AGENT][NEUTRAL] 10 days of service.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected and the member's policy number?
[CUSTOMER][NEUTRAL] Yeah. The contact number is [PII]. And the member policy number was 02348343.
[AGENT][NEUTRAL] OK, and can you repeat the phone number slowly for me, please? I'm sorry.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] What
[AGENT][POSITIVE] Thank you for that. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] The first name was [PII] and the date of birth was [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have all the dates of service and the total bills?
[CUSTOMER][NEUTRAL] We'll go by one by one or do you need the entire thing?
[AGENT][NEUTRAL] I would like all 10 together with the total bill, please.
[CUSTOMER][NEUTRAL] OK. So the first date of service was [PII] and the bill amount was $1,471.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the next date of service was [PII] with the bill amount of $37.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And the next one is uh 10 1 [PII] and the bill amount is $184.
[CUSTOMER][NEUTRAL] 184. OK.
[AGENT][POSITIVE] Yes, I'm following you. I'm ready for the next one.
[CUSTOMER][NEUTRAL] And the next one, yeah. The next one is 928 2024 with the amount of $522.
[CUSTOMER][NEUTRAL] And the next one is uh 9202024 with the amount of $30.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] 425 2024 with the amount of $74.
[CUSTOMER][NEUTRAL] And the next date of service is [PII] with the amount of $356.
[CUSTOMER][NEUTRAL] That will help you.
[CUSTOMER][NEUTRAL] And the next one is 423 [PII] with the bill amount of $134.
[CUSTOMER][NEUTRAL] Next one will be $424 2024 with the amount of $134.
[CUSTOMER][NEUTRAL] 424 1234. And the last one is 622 2024 with the amount of $871.
[CUSTOMER][NEUTRAL] That's it.
[AGENT][NEUTRAL] All right. And is it OK if I place you on just a brief hold while I go through the claims for you?
[CUSTOMER][POSITIVE] Yeah, sure, no issues.
[AGENT][NEUTRAL] And can you verify the name of the provider's facility on the claims?
[CUSTOMER][NEUTRAL] Yeah, sure. The provider was the Permanent Medical Group.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEGATIVE] We're not gonna be going on a call for 30 million hours.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 28, she got.
[AGENT][NEUTRAL] 4,713,521,790 DH 2075.
[AGENT][NEUTRAL] Which, what else is for the [PII], 522.
[AGENT][NEUTRAL] And why not give them together now for the 8 047.
[AGENT][NEUTRAL] The $30 3529142382079.
[AGENT][NEUTRAL] Anything else for the [PII]? No, let's go to the [PII].
[AGENT][NEUTRAL] $37 3521793 DH oops.
[AGENT][NEUTRAL] 278, anything else for the [PII] or the [PII]? No, let's go to the next 1 [PII].
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 0
[AGENT][NEUTRAL] 184 there you go. 252-9150 DH 2078.
[AGENT][NEUTRAL] 425.
[AGENT][NEUTRAL] 740.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] What?
[AGENT][NEUTRAL] 14 3670 yeah, that's 74.
[AGENT][NEUTRAL] The math and 7223 DC 7500 oops.
[AGENT][NEUTRAL] 04 2024.
[AGENT][NEUTRAL] $65 67,500.
[AGENT][NEUTRAL] 1343529145 DC 100.
[AGENT][NEUTRAL] It's a different data service for [PII].
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I know.
[AGENT][NEUTRAL] 1343521 243529124 PC 3500.
[AGENT][NEUTRAL] [PII].
[AGENT][NEGATIVE] 871, that's a dupe with the original.
[AGENT][NEUTRAL] Send us to do the the original.
[AGENT][NEUTRAL] 351-7208 D80016 OK.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] 790.
[AGENT][NEUTRAL] What is it? 352-515-2.
[AGENT][NEUTRAL] The age
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Alright, thank you so much for holding. I apologize for that wait. So again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So for the first amount, the $1,471 for [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We received that claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That claim number is 3,521,790.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I got I.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because the calendar year max for outpatient accident and sickness treatments in the emergency room has been met.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] It means
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] It means
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] It means that the benefit was maxed out for the calendar year for emergency rooms.
[CUSTOMER][POSITIVE] Maximum benefits has been reached, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Has been exceed. May I know how many, uh, is it, uh, maximum benefits has been accessed as per visits or dollar value?
[AGENT][NEUTRAL] It's the visit. It's 2 emergency room visits per calendar year.
[CUSTOMER][NEUTRAL] Only 2 emergency visits are allowed per calendar year, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] May I know when the last visit was taken?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Um, hold on one moment, I have to go through all their claims.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um, I can give you the, are you asking for, I'll give you the date that the claim finished processing on [PII], but it's a different provider's claim.
[CUSTOMER][NEUTRAL] So the last visit was performed on [PII], right?
[AGENT][NEUTRAL] No, the last claim process paying that benefit was [PII].
[CUSTOMER][NEUTRAL] So, can I have the date of service of that time?
[AGENT][NEUTRAL] No, because it's a different provider's claim, so you just ask when was that benefit exhausted? It was exhausted on [PII].
[CUSTOMER][NEUTRAL] OK. So what I am asking is you have two emergency visits is only allowed per calendar year, right? So I was asking when the last uh emergency visit was performed, the date.
[AGENT][NEUTRAL] Right, but I can't give you another provider's claim status. However, I can let you know when that claim process. So the benefit has been exhausted for the year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. For different provider, so you're unable to provide the other information.
[CUSTOMER][NEUTRAL] Is that right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. Uh, shall we move to the next client?
[AGENT][NEUTRAL] So the next amount of 522,520, do you want me to go in dates of service or the order you gave me?
[CUSTOMER][NEUTRAL] The order I gave you.
[AGENT][NEUTRAL] So [PII], the $37.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] 352.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] 217.
[CUSTOMER][NEUTRAL] What.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] I don't see that.
[CUSTOMER][NEUTRAL] a physical.
[AGENT][NEUTRAL] 93. OK, so that claim was received on [PII]?
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 352.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] 1793.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] As the medical test for this date of service is not a covered diagnostic test.
[CUSTOMER][NEUTRAL] and
[CUSTOMER][NEUTRAL] So is it non-covered? Diagnosis or non-covered?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] It's a non-covered diagnostic test.
[CUSTOMER][NEUTRAL] Non-OV diagnostics. OK, that's fine.
[CUSTOMER][NEUTRAL] So diagnosis are non-covered as per patient plan or provider plan.
[AGENT][NEUTRAL] Um, the patients plan.
[CUSTOMER][NEUTRAL] As for patient plan. That's fine. No issues. Uh shall amount to the next.
[AGENT][NEUTRAL] So [PII] for $184 that was received on [PII].
[CUSTOMER][NEUTRAL] Next one.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You didn't
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] The claim number is 352.
[AGENT][NEUTRAL] 9150.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And on [PII], the claim was denied for the same reason. It's a non-covered diagnostic test.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. That's fine.
[AGENT][NEUTRAL] So the next one, hold on.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, we received [PII], um, for the 5/22 we received on [PII].
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] And that claim number is 352.
[AGENT][NEUTRAL] 9145.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] And on [PII], the claim was denied?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Because the calendar year maximum on diagnostic tests has been met.
[CUSTOMER][NEUTRAL] So how many uh
[CUSTOMER][NEUTRAL] Is it a maximum benefits as may reach as per visits or dollar value?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] It's per, um, neither one, it's one image per year.
[CUSTOMER][NEUTRAL] It's one image services per year, right?
[AGENT][NEUTRAL] Right, and then there's another benefit for a follow-up, but this one is just for the initial testing.
[CUSTOMER][NEUTRAL] So, may I know when the last image service has been performed?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] I can let you know the the date that the claim processed on that exhausted the benefit.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Um, that was also [PII].
[CUSTOMER][NEUTRAL] [PII]. That's fine.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] So the next claim for [PII] for $30 that claim number is 35, 0 well, it was received on [PII].
[CUSTOMER][NEUTRAL] OK, shall we move to the next one?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The claim number is 352.
[AGENT][NEUTRAL] 9142.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because the calendar year maximum for the accident and surgery benefit has been exhausted.
[CUSTOMER][NEUTRAL] So is it exactly as per visit or uh dollar value?
[AGENT][NEUTRAL] Um, let me see if this one.
[AGENT][NEUTRAL] It's not visits, it's
[AGENT][NEGATIVE] At a hospital facility, it's one per year, so that was exhausted.
[CUSTOMER][NEUTRAL] So, the, the service is allowed only once per year.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Right. Uh, may I know when the last service was taken on?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But I
[AGENT][NEUTRAL] Do you mind if I place you on a brief hold so I can go through the claims?
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] Sure. You are on hold.
[AGENT][POSITIVE] Thank
[AGENT][NEGATIVE] This is ridiculous.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] This is crazy.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hey.
[AGENT][NEUTRAL] Uh, that might have helped. Um, it's 234-834-3.
[AGENT][NEUTRAL] Because I just gave her the date last claim was processed. I told her I can't give her the claim information.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I mean,
[AGENT][NEUTRAL] It's the provider, but it's a different provider than, so the claim that exhausted the benefit is a different provider than who's calling. So I just told her it was exhausted on [PII], which is when the claim was processed, but I'm not telling her.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, I just wanted to make sure because I'm like, I'm not going through all these claims.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK. I just want to make sure. That's it, but she keeps asking me if something, if the remarks saying something's outstanding, I mean, maxed out, then she's like, OK, well, when was it maxed out? And I said, well, that's a different provider's claim, but the claim processed on [PII], and she said, well, when was it performed? I said I can't give you that because it's a different provider, but this is when the benefit was exhausted.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Um, well, to be honest, it's 10 days of service, so it's a lot.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] To file an appeal, but you can't.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] OK, well, thank you.
[AGENT][NEUTRAL] Mhm, but it's, I mean, I'm fine. I just wanted to make sure it wasn't something else to do.
[AGENT][POSITIVE] OK, well, she'll just get what I'll give her. All right, thank you.
[AGENT][NEUTRAL] All right, bye bye.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. So that claim, um, processed on [PII], that exhausted this benefit.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] [PII], I'm sorry, [PII] exhausted this benefit. So when your claim came in, the benefit was already used.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. The services are only once per year and the last visit was performed on [PII]. So it was um exhausted, right?
[AGENT][NEGATIVE] It wasn't performed. That's when the claim processed that exhausted the benefit.
[CUSTOMER][NEUTRAL] OK, that's fine.
[CUSTOMER][NEUTRAL] Selling on to the next data service, I mean, next one.
[AGENT][NEUTRAL] Mhm. So [PII] for $74 that was received on [PII].
[AGENT][NEUTRAL] The claim number is 351.
[AGENT][NEUTRAL] 7223.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] And I'm waiting for that reason to come up now.
[AGENT][NEGATIVE] Um, because the premium for that date of service was not received, therefore, um, benefits are not payable.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sorry, is it non-covered?
[AGENT][NEUTRAL] The premium
[AGENT][NEGATIVE] For this service date was not received.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Therefore, benefits are not payable.
[CUSTOMER][NEUTRAL] It was not, so it's non-covered as per patient plan, right?
[AGENT][NEGATIVE] No, the premium, their insurance premium was not received. Therefore, benefits could not be paid out.
[CUSTOMER][NEUTRAL] It means
[AGENT][NEUTRAL] For your insurance policy, you have to pay for your policy weekly or monthly. They, the pre the
[CUSTOMER][NEUTRAL] So is it deductible?
[AGENT][NEGATIVE] No, it's a premium. They what they pay to keep their policy was not received.
[AGENT][NEUTRAL] So we can't pay out on claims when they didn't pay for their insurance.
[CUSTOMER][NEUTRAL] So it's a non-pay as for uh uh patients and the insurance plan, right?
[AGENT][NEGATIVE] The denial reason is the premium for this date of service was not received. Therefore, benefits are not payable.
[CUSTOMER][NEUTRAL] OK, that's fine. So shall you know to the next.
[AGENT][NEUTRAL] Yes, and that's actually the denial reason for the next 3 days of service, but I can let you know when the claim was received and processed and the claim number.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Is it the same? And what is the total premium allowed per year?
[AGENT][NEUTRAL] OK, wait, wait, wait, wait. That's not what I'm saying. I'm saying the denial reason for the next 3 days of service that we're gonna go through are the same denial reason, but I can give you when those claims were received, processed, and the claim number.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And I cannot give you the insured premium that they pay for their insurance.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So for [PII], the $356.
[AGENT][NEUTRAL] That claim, hold on one moment.
[CUSTOMER][NEUTRAL] OK that's
[CUSTOMER][NEUTRAL] time.
[AGENT][NEUTRAL] Alright, so that was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That claim number is 352-9145.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] Is it 45 or 26?
[AGENT][NEUTRAL] 352-914-5.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the same denial premium for the service is non-received, so benefits are non-payable as per the patient plan.
[AGENT][NEUTRAL] Right, the premium wasn't received, so the benefits are not payable.
[CUSTOMER][NEUTRAL] OK. Shall we move on to the next year of service? I mean, next one?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So that's, OK, wait a minute. So 423-2024, the 356, that claim number is 352-9126.
[AGENT][NEUTRAL] The amount of 134 is 352-9145. I don't know if
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We got, I don't know.
[CUSTOMER][NEUTRAL] OK, OK. I got it.
[AGENT][NEUTRAL] The next date of service 424 for $134.
[CUSTOMER][NEGATIVE] Oh shit.
[AGENT][NEUTRAL] was also received on [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That claim number is 352-9124.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Same denial.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And what about the last one?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Um, that was received on [PII].
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] And that claim number is 351.
[AGENT][NEUTRAL] 7208.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Because the benefit maximum for this data service has been met.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So is it maximum benefits has been excessed as per visits or dollar value?
[AGENT][NEUTRAL] Per visit?
[CUSTOMER][NEUTRAL] Uh, how many is it is it allowed?
[AGENT][NEUTRAL] For the emergency room, um, let me go back. I believe it was 2. Hold on one moment. Yes, it's 2 per calendar year.
[CUSTOMER][NEUTRAL] 2 visits for [PII].
[CUSTOMER][NEUTRAL] OK. When was the last visit was performed?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 24. OK, that's fine.
[AGENT][NEUTRAL] That's not when it was performed, that's when the claim was processed.
[CUSTOMER][NEUTRAL] OK, that's fine. Uh.
[CUSTOMER][NEUTRAL] So it is allowed only 2 visits per calendar year, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK, so can I have a reference number for this call?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name and today's date and my name is [PII] The [PII], and then today's date.
[CUSTOMER][POSITIVE] So and then thank you so much for your blessed and wonderful patience. Thank you bye bye.
[AGENT][POSITIVE] Thank you also and thanks for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] Thank you.