AccountId: 011433970860
ContactId: 8fd7b12d-5bfc-4042-98ad-36565857bcc1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 477660 ms
Total Talk Time (AGENT): 119914 ms
Total Talk Time (CUSTOMER): 175235 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/8fd7b12d-5bfc-4042-98ad-36565857bcc1_20250107T18:44_UTC.wav
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[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my
[CUSTOMER][NEUTRAL] Hi, my name is [PII], looking for claim information.
[AGENT][NEUTRAL] OK [PII], I can help you with the claim. Can you please give me your callback number just in case our call is disconnected.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you sir and then what is the patient's name?
[CUSTOMER][NEUTRAL] Just a moment. Patient name is [PII], and after that is [PII] Date of birth, [PII].
[AGENT][NEUTRAL] OK, and what's the patient's policy number?
[CUSTOMER][NEUTRAL] It's 60801.
[CUSTOMER][NEUTRAL] Mm, just a moment. The policy number, the, uh, just a moment. Now, the policy number is 02456868.
[AGENT][NEUTRAL] Uh, that is, yeah.
[AGENT][NEUTRAL] 02456668
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, let me pull that policy in for us.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I don't believe that's the right policy number. Can you give me the policy number again, please?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And the policy number I have 02456868. It's the same policy number showing it's the same reference number showing. I'm not sure which one is the uh uh correct one.
[AGENT][NEUTRAL] OK, so 02456.
[CUSTOMER][NEUTRAL] So could you check with the member uh member name if you're not found it?
[AGENT][NEUTRAL] 56
[CUSTOMER][NEUTRAL] It's 02456868.
[AGENT][NEUTRAL] Uh, if you can just give me the policy.
[AGENT][NEUTRAL] 686 8.
[CUSTOMER][POSITIVE] If you want, I can, yeah, right.
[CUSTOMER][NEUTRAL] If you want, I can give you the claim number.
[AGENT][POSITIVE] Yes, the claim number would be helpful, thank you.
[CUSTOMER][NEUTRAL] Yeah, that will be 3485546.
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and what is the date of service?
[CUSTOMER][NEUTRAL] The date of service is [PII]. Total charge will be, let me check you the total charge is $350. And I have one specific question for this one.
[AGENT][NEUTRAL] OK and then what is the name of the facility you're calling for?
[CUSTOMER][NEUTRAL] Medical specialist of Palm Beach?
[AGENT][NEUTRAL] OK, thank you. Let me pull in the claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] the way.
[AGENT][NEUTRAL] OK, I do show that um.
[AGENT][NEUTRAL] The claim was paid.
[AGENT][NEUTRAL] After the claim was paid, it maxed out.
[CUSTOMER][NEUTRAL] Yeah, we already received the EOB.
[AGENT][NEUTRAL] Right after the claim was paid it maxed out the benefits for the calendar year.
[CUSTOMER][NEUTRAL] So actually, what happened, uh primary insurance left the patients responsibility $53 and you process only 25. $34 right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So what is the reason?
[AGENT][NEUTRAL] Because
[AGENT][NEUTRAL] So when the $25.34 was paid.
[AGENT][NEGATIVE] It maxed out the benefits for the calendar year it exhausted the benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, max max benefit?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Could you repeat the line? Your voice is in and out.
[AGENT][NEGATIVE] After the claim was paid, it maxed out the benefit for the year. It exhausted the benefit.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, still, still, your voice is in and out. I, I'm understanding that the claim was processed correctly as after the claim was paid, it's exhausted the benefit.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Max benefit.
[CUSTOMER][POSITIVE] OK, Max benefit. OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And how much is the total benefit? I mean, how much is the amount in dollar?
[AGENT][NEUTRAL] Uh, let me look for you.
[AGENT][NEUTRAL] The plan only covers $500 per calendar day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you repeat the name?
[AGENT][NEUTRAL] The plan only covers $500 per day.
[CUSTOMER][NEUTRAL] Per calendar day, right? Uh, per calendar year, sorry.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, plan only covers $500 per calendar year.
[AGENT][NEUTRAL] Calendar day.
[CUSTOMER][NEUTRAL] Calendar day, day.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] It's day, right?
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So, so it should be covered until $500 per klo day.
[CUSTOMER][NEUTRAL] So it should be covered for our uh whole amount if it is covered 500. And how much is all, mhm.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] You weren't the only claim for that day.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] There was more claims for that day that were paid.
[CUSTOMER][POSITIVE] OK, there is, OK. There's more um more claim you have on there which was already met or exhausted, right? OK, not an issue. Thank you so much. That's from my side.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you so much, [PII].
[CUSTOMER][POSITIVE] Mhm welcome.
[AGENT][POSITIVE] You have a good day and thank you for calling APL.
[CUSTOMER][NEUTRAL] Same, ma'am. Bye-bye.