AccountId: 011433970860
ContactId: 8a89e7e3-258d-41d3-b631-7d8b91f66fb7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 186679 ms
Total Talk Time (AGENT): 86456 ms
Total Talk Time (CUSTOMER): 47730 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/8a89e7e3-258d-41d3-b631-7d8b91f66fb7_20250106T17:07_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] at Prisma Health. I was checking on a claim.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the claim status, [PII]. May I have a good contact number in case we're disconnected and the member's policy number?
[CUSTOMER][NEUTRAL] 8646956252. The policy number is, is that the D or the 02 number?
[AGENT][NEUTRAL] 02.
[CUSTOMER][NEUTRAL] 02481710
[AGENT][NEUTRAL] Thank you for that. And [PII], can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [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] [PII].
[CUSTOMER][NEUTRAL] Through the [PII], $16,595.70.
[AGENT][NEUTRAL] 16,500, and can you repeat that number?
[CUSTOMER][NEUTRAL] 9570 cents.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And again, just for the call, the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment while I look for this claim for you.
[AGENT][NEUTRAL] I just press my house.
[AGENT][NEUTRAL] So I'm sure we received the claim on [PII].
[AGENT][NEUTRAL] That claim number is 354.
[AGENT][NEUTRAL] 1198.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] As the maximum benefit for the outpatient sickness rider has been exhausted for the calendar year.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Does he have any benefits with IMA or just you guys?
[AGENT][NEUTRAL] Oh, just us. I may um just kind of like the re repricing for the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is there any multipla discount or just the full thing is his?
[AGENT][NEUTRAL] Um, let me see, so this went to IMA, so there's, I guess there was no discount. That's what they would have applied and sent us the.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] I like the difference.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Thanks, is there a call reference number?
[AGENT][NEUTRAL] You're very welcome, [PII]. No, there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Alright you have a good day thank you.
[AGENT][POSITIVE] You also thanks for calling APL. Bye bye.
[CUSTOMER][POSITIVE] Thank you. Bye.