AccountId: 011433970860
ContactId: a1c8e17e-9e39-4fb9-81d9-0b274a0feadb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 175009 ms
Total Talk Time (AGENT): 34966 ms
Total Talk Time (CUSTOMER): 64788 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/a1c8e17e-9e39-4fb9-81d9-0b274a0feadb_20250411T15:55_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I was calling. I had a question regarding a claim.
[AGENT][NEUTRAL] Are you with the provider's office or is this for yourself?
[CUSTOMER][NEUTRAL] Uh, from the provider's office.
[AGENT][NEUTRAL] I.
[AGENT][NEUTRAL] OK. Um, do you have a good callback number, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Uh yes, I do.
[CUSTOMER][NEUTRAL] It is 01849095.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII], [PII].
[AGENT][NEUTRAL] OK, what was that date of service?
[CUSTOMER][NEUTRAL] Uh, this one was for, uh, [PII]. It was for $14,599.
[AGENT][NEUTRAL] OK, I'm sorry, I clicked out of the wrong thing. Can you give me that policy number one more time? So sorry.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, 01849095.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] Uh, it looks like we had denied the claim for outpatient benefit for the calendar year had been met.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] It's just because it would normally be covered, it's just their benefits have been met.
[AGENT][POSITIVE] Yes, they've maxed out their benefits, yeah.
[CUSTOMER][NEUTRAL] Or exhausted.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh OK, that's what I wanted to check on because I saw that there was a denial, but I, I wasn't sure if it was because something to do with the EOB from Blue Cross or what it was, um.
[CUSTOMER][NEUTRAL] So yeah I just wanted to give you guys a call and check on that but it's because benefits are exhausted. Uh, is there a reference number that I can grab from you?
[AGENT][NEUTRAL] Uh, reference number is just my name, [PII], first initial to last name, [PII], and today's date.
[CUSTOMER][POSITIVE] Appreciate it.
[AGENT][POSITIVE] Good, thanks for calling APL. Have a good day.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][NEUTRAL] OK.