AccountId: 011433970860
ContactId: 8ad7f35e-399e-4b8d-b380-5ee7ca004352
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 331290 ms
Total Talk Time (AGENT): 112903 ms
Total Talk Time (CUSTOMER): 155764 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/8ad7f35e-399e-4b8d-b380-5ee7ca004352_20250131T21:07_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hello, [PII]. Uh, I'm [PII], uh, calling from provider's office regarding our claims.
[AGENT][POSITIVE] OK, I'll be more than happy to assist you with the claim status, [PII]. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Mm, for me, uh, total 3 claims, [PII], that's it.
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. [PII] with an extension of [PII]. Mhm.
[AGENT][NEUTRAL] Thank you for that. And may I have the first member's policy number?
[CUSTOMER][NEUTRAL] Sure. My policy number is 01826103. M as in Mike L as in Lima, L as in OK, M as in Mike as 88. Mhm.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] My first name is?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Uh [PII], last name is [PII].
[CUSTOMER][NEUTRAL] Some.
[AGENT][NEUTRAL] Thank you. And the date of birth?
[CUSTOMER][NEUTRAL] Sure. Uh, the date of birth is going to be.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service of the claim you like me to check on?
[CUSTOMER][NEUTRAL] So, the service is uh [PII], I'm sorry, it's [PII] with the bill amount of 3480 even.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] 3480 $3480?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment while I locate that claim for you.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] The name of the provider's office and the claim is uh Gastro Galloway anesthesia.
[CUSTOMER][NEUTRAL] Associates.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'm showing we received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3336834.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the the claim was denied.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Because the maximum benefit payable for this data service has been met.
[CUSTOMER][NEUTRAL] OK. I just wanted to make sure as per the dollar amount or as for the?
[CUSTOMER][NEUTRAL] With you bye bye.
[AGENT][NEUTRAL] The dollar amount.
[CUSTOMER][NEUTRAL] Could you please help me out, uh, maximum dollar amount as per year? How much is it?
[CUSTOMER][NEUTRAL] All of the one.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the benefit is up to $750 per calendar day?
[CUSTOMER][NEUTRAL] As per calendar day, right?
[AGENT][NEUTRAL] Yes, so by the time your claim came in, the total of $750 was already used for your date of service.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it. Uh, could you please help me which, uh, under which claim number or which under which under which data service the claim was already paid.
[AGENT][NEUTRAL] No, unfortunately, I can't give that information because it's another claim that does not belong to your provider. However, for your claim, the um benefit had been used before it was
[AGENT][NEUTRAL] Um, processed.
[CUSTOMER][NEUTRAL] OK, I, I do understand. OK. Uh, I just wanted to confirm, like, uh, I just wanted to make sure. I need a little more information like for which date of service the claim was already processed and paid. That's it all right.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], the $750 has already reached, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Sure, just give me a second.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Uh, can you repeat the date April, uh, I'm sorry, can you repeat the date on which data service?
[AGENT][NEUTRAL] Yes, your date of service is [PII].
[CUSTOMER][NEUTRAL] No, uh, for which data services was already maximum benefits have been exhausted.
[AGENT][NEUTRAL] I understand your question, sir. I can't give you that answer because it does not belong to your provider. So for your claim, the denial reason is the the benefit had been used for the data service. For [PII], the $750 for the calendar day was used before your claim was processed. Would you like to move to the next member?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Got it. I don't understand.
[CUSTOMER][NEUTRAL] Mhm. I move to another club, yeah.