AccountId: 011433970860
ContactId: 86c83e9c-aa79-46f1-bc51-35f634f7d6f9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 243440 ms
Total Talk Time (AGENT): 91488 ms
Total Talk Time (CUSTOMER): 83549 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/86c83e9c-aa79-46f1-bc51-35f634f7d6f9_20250226T18:50_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] Hi, this is [PII] calling from office checking on claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, [PII]. May I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, my contact number is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, ma'am that policy number is
[CUSTOMER][NEUTRAL] 1330836 M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, my first name is [PII], and date of birth is [PII].
[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 the date of service for the claim?
[CUSTOMER][NEUTRAL] His date of service is [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] His total bill amount is $3,252.75.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] May I have your name?
[AGENT][NEUTRAL] Yes, my name is [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the um facility on the claim?
[CUSTOMER][NEUTRAL] Yes, facility name is Samrain Hospital.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Saritian Hospital.
[AGENT][NEUTRAL] Thank you. So I'm showing that we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 352.
[AGENT][NEUTRAL] 228 5.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because the outpatient benefit for the calendar year has been used.
[CUSTOMER][NEUTRAL] Uh, can I have a total, uh, annual?
[CUSTOMER][NEUTRAL] Dollar amount
[AGENT][NEUTRAL] Yes, for outpatient it's up to $750 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it has already been matched.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Uh,
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] One minute. Uh, the claim number is 35.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 352-228-5.
[CUSTOMER][NEUTRAL] OK. Uh.
[CUSTOMER][NEUTRAL] And one, could you please send me a copy of you on this?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] Uh, the fax number is.
[CUSTOMER][NEUTRAL] One minute, it's 248.
[CUSTOMER][NEUTRAL] 233-245 2
[CUSTOMER][NEUTRAL] Attention to my name, [PII].
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And that was [PII]?
[CUSTOMER][NEUTRAL] Yes, it used to be correct.
[AGENT][POSITIVE] All right, well, I will go ahead and send the explanation of benefits over to you now. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Uh, no, currently I don't have anything. Could you please help me with the call reference for this?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name and today's date. And again, the first initial of my last name is [PII], my first name is [PII]
[CUSTOMER][POSITIVE] OK, thank you and uh thank you so much for assisting. Have a great day. Bye for now.
[AGENT][POSITIVE] You're very welcome.
[AGENT][POSITIVE] Thanks for calling APL bye bye.
[CUSTOMER][NEUTRAL] Right.