AccountId: 011433970860
ContactId: 938a4658-d99d-4655-bc4e-6c6af3cc12ef
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 318750 ms
Total Talk Time (AGENT): 134175 ms
Total Talk Time (CUSTOMER): 89609 ms
Interruptions: 0
Overall Sentiment: AGENT=2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/938a4658-d99d-4655-bc4e-6c6af3cc12ef_20250113T18:12_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Yes [PII], my name is [PII] and I'm with South Florida Urology. I have a claim that I submitted, but I need to double check on the eligibility to see if the patient, uh, still has, um, the insurance if you could help me.
[AGENT][POSITIVE] Yeah, I'd love to help you with that, Miss [PII]. Do you mind if I get a good call back number from you real quick?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][POSITIVE] Wonderful. And the member's policy number?
[CUSTOMER][NEUTRAL] It is, it is 01851504.
[AGENT][NEUTRAL] And give me just a moment to get that pulled up for you.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Perfect. Would you be able to verify for me, please, your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK perfect I really appreciate that. [PII] is current and active. It looks like his effective date is [PII] and then.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Are you needing any more information as far as like, I know you said you had put a claim in.
[CUSTOMER][NEUTRAL] Um, yeah, we, I put a, we put a claim in for October of last year, but I don't see, um, anything further on it, so I don't even know if, uh, you guys had received that claim. Would you be able to check that or no?
[AGENT][NEUTRAL] Yeah, I can definitely check claim status for you. You said it was [PII]?
[CUSTOMER][NEUTRAL] It's uh it's [PII] for a billed amount of $265.
[AGENT][NEUTRAL] OK, yes, so actually I think it's this one right here. Hold on one second.
[AGENT][POSITIVE] All right, perfect. I do see that right here. I can give you claim status if you'd like.
[CUSTOMER][NEUTRAL] OK, yes, please.
[AGENT][NEUTRAL] All right, it does look like we received the claim on, I cannot talk. I'm so sorry, [PII], and it was processed on the same day, [PII]. I have your claim number listed as 3531355, and I do show the claim denied. I have the reason stating.
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Um, the calendar year policy maximum of 4 doctor office visits per person has been met. There are no further payable benefits for this calendar year for the individual.
[CUSTOMER][NEUTRAL] OK, OK, alright, um, with that being said, then, would you be able to, uh, fax me over the explanation of payment by chance to show that because I need that in order to adjust the account.
[AGENT][POSITIVE] Yeah, I can absolutely work on getting that fax to you. Give me just one second to get that pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. I think my system knows it's Monday.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] I think we all have that problem.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][POSITIVE] All right, it's so close. I'm almost there, my friend.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, and I'm just waiting for that fax box to load, um, but while I'm waiting for it to load, do you mind if I get the fax number?
[CUSTOMER][NEUTRAL] Uh yes, it's uh 501.
[CUSTOMER][NEUTRAL] 687.
[CUSTOMER][NEUTRAL] 9276.
[AGENT][POSITIVE] Perfect, thank you.
[AGENT][NEUTRAL] And are you wanting that made attention to yourself, Ms. [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, yes, just put [PII] that way it gets over to me.
[AGENT][POSITIVE] Yes, absolutely.
[AGENT][NEUTRAL] All right. And
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] All right, I'm gonna send on that right now for you. It should be coming your way. And is there anything else I can do for you today?
[CUSTOMER][NEUTRAL] No, that's all I needed if I could just get a reference number for the call.
[AGENT][NEUTRAL] Hey, you betcha. It's gonna be my name, [PII], first initial last name, [PII], and today's date.
[CUSTOMER][POSITIVE] All right thank you very much you have a good day.
[AGENT][POSITIVE] My pleasure, Ms. [PII]. You too and thank you for calling APL.
[CUSTOMER][NEUTRAL] Uh huh bye bye.
[AGENT][NEUTRAL] Bye-bye.