AccountId: 011433970860
ContactId: 7bedcb50-cc8c-4294-b1ab-47c96c91b34e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 301480 ms
Total Talk Time (AGENT): 126226 ms
Total Talk Time (CUSTOMER): 92333 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/7bedcb50-cc8c-4294-b1ab-47c96c91b34e_20250217T17:28_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][POSITIVE] Good morning. This is [PII]. Hope you're having a good day.
[AGENT][NEUTRAL] Uh, it's fine, and I'm sorry, your name is again?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Spell your name for me, please.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK, and how may I assist you today?
[CUSTOMER][NEUTRAL] I'm here for a claim status.
[AGENT][NEUTRAL] OK, I can verify claim status for you now. And what is the policy number, please?
[CUSTOMER][NEUTRAL] Policy number is 01940423.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] OK, thank you. And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Patient's name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, and the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] Day of services [PII] and the amount is $1,762.52.
[AGENT][NEUTRAL] 51 cents?
[CUSTOMER][NEUTRAL] 52 cents.
[AGENT][NEUTRAL] I'm sorry, your phone cut out when you said the last digit, say again.
[CUSTOMER][NEUTRAL] Uh, it's 5150, I'm sorry, it's 52.
[AGENT][NEUTRAL] 51 cents.
[AGENT][NEUTRAL] 52 cents. OK. And while I'm looking up claim information, let you know we do have an online service center where providers can check claim status as well as print out the EOB. That site is at [PII].
[CUSTOMER][NEUTRAL] No, I'm sorry, it's 52. Yeah.
[AGENT][NEUTRAL] And you're calling from?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] AdventHealth Tom Coast.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] I'm showing the claim process is the maximum payment for this outpatient occurrence has been met.
[CUSTOMER][NEUTRAL] Uh, I'm sorry. Can you please repeat?
[AGENT][NEUTRAL] The claim process as the outpatient benefit for this occurrence has been met.
[CUSTOMER][NEUTRAL] OK. And what's the claim number?
[AGENT][NEUTRAL] Claim number 3562282.
[CUSTOMER][NEUTRAL] OK. And when was it received?
[AGENT][NEUTRAL] Uh, the claim was received on, give me a moment.
[AGENT][NEUTRAL] Uh, claim receipt [PII], processed on [PII].
[CUSTOMER][NEUTRAL] And it won't be paid?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, won't it be paid?
[AGENT][NEUTRAL] No, the claim process as the outpatient benefit has maxed for this occurrence.
[CUSTOMER][NEUTRAL] Benefit max, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And what's the total number of benefits?
[AGENT][NEUTRAL] Well, under this policy, the insured has a benefit max that pays for outpatient up to $250 per occurrence.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] $250 and that has already met the $250.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Got it. Just give me a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, but upon checking, we have not received any payments.
[CUSTOMER][NEUTRAL] From this, from the insurance.
[AGENT][NEUTRAL] OK, well, with this policy or with this claim, the insurer has already met their max, so it could have been from another provider for the same or related condition that has made it max, but the insured has already met their outpatient benefit max for this occurrence.
[CUSTOMER][NEUTRAL] OK, got it. Lastly, can you spell your name and give the call reference number?
[AGENT][NEUTRAL] Uh, we don't give reference numbers. You may use my name in today's date, and my name is spelled [PII].
[CUSTOMER][POSITIVE] OK, OK. Got it. Thank you so much for helping me.
[AGENT][POSITIVE] You're welcome. Thank you for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.
[AGENT][NEUTRAL] Mhm bye.