AccountId: 011433970860
ContactId: a4d03f51-7b2b-486d-a1dd-f5ec8666c968
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 332230 ms
Total Talk Time (AGENT): 119517 ms
Total Talk Time (CUSTOMER): 138534 ms
Interruptions: 4
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/a4d03f51-7b2b-486d-a1dd-f5ec8666c968_20250422T14:37_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Are you there
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. My name is [PII]. I'm calling from provider office and I have one claim in which I need your assistance.
[AGENT][NEUTRAL] OK, yeah, I can look at a claim for you. I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] He said [PII].
[CUSTOMER][POSITIVE] Yeah, correct, correct.
[AGENT][NEUTRAL] OK, um, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] And you, mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, my callback number is [PII]. It's a direct line, and may I know your name?
[AGENT][POSITIVE] OK, thank you. And then
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] and the last initial.
[AGENT][NEUTRAL] It's A
[CUSTOMER][NEUTRAL] OK, thank you, [PII]. Go ahead.
[AGENT][NEUTRAL] Of course. Do you have that policy number?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah, wait.
[CUSTOMER][NEUTRAL] Yeah, it's uh 01663528.
[CUSTOMER][NEUTRAL] M as in Mary, L as in Lima, 8.
[AGENT][NEUTRAL] OK, and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, do you have that date of birth?
[CUSTOMER][NEUTRAL] Yeah, I did.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, can you hear me?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yeah, yeah, sure.
[AGENT][NEUTRAL] Did you have that date of birth for this number?
[CUSTOMER][NEUTRAL] It's [PII] and I'm yeah.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that and then what was the uh do you have the claim number?
[CUSTOMER][NEUTRAL] No, we don't have any claim number.
[AGENT][NEUTRAL] OK, sure uh what was the date of service?
[CUSTOMER][NEUTRAL] I think yeah.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] And do you have that bill amount?
[CUSTOMER][NEUTRAL] It's $4,387.
[AGENT][NEUTRAL] OK, that was $4,387.
[CUSTOMER][POSITIVE] Yeah, correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then do you have the uh tax ID for the provider setting?
[CUSTOMER][NEUTRAL] Yeah, I have. And the tax ID is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you for that one moment please.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, so I have one claim on file for this state of service from this provider, uh, that was for the bill amount of uh $2,368.98. Was that the amount left over after a major medical?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, um, so for this claim we did pay a benefit of $1500. Give me just a moment. I believe that met their maximum.
[CUSTOMER][NEUTRAL] see.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Yes, uh, so that $1500 did meet their maximum.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] So maximum in what terms like for for every visit or?
[AGENT][NEUTRAL] Um, the, the benefit amount, the benefit amount, um, so let me go back here, give me just a moment, so their outpatient benefit, it's $1500 max per calendar year.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So that was the maximum amount payable.
[CUSTOMER][NEUTRAL] OK, OK, OK.
[CUSTOMER][NEUTRAL] OK, OK. Uh, according to, uh, and the rest amount would be PR.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And the balance amount should be PR patient responsibility or anything.
[AGENT][NEUTRAL] Um, we don't say what is patient responsibility, that would be up to the provider.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, OK, OK. OK. Thank you very much. May I know the call reference number?
[AGENT][NEUTRAL] Sure, that would just be my first name, last initial, and today's date. Um, did you need this claim number or anything, Sunny?
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, uh, that's 356-3092.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][POSITIVE] Thank you very much, you. Have a good day. Bye-bye.
[AGENT][NEUTRAL] Of course. Was there anything else I can help you with?
[AGENT][POSITIVE] Alright, thanks for calling APO. You too. Thank you. Bye bye.
[CUSTOMER][POSITIVE] No, thank you very much. Bye bye.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.