AccountId: 011433970860
ContactId: a8e37ed4-603e-4ddb-8c7e-b547f0e6ce50
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 284779 ms
Total Talk Time (AGENT): 101612 ms
Total Talk Time (CUSTOMER): 94264 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/a8e37ed4-603e-4ddb-8c7e-b547f0e6ce50_20250123T13:21_UTC.wav
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[AGENT][NEUTRAL] This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling from Medical University Hospital, checking on plan.
[AGENT][NEUTRAL] Can help you [PII]. What's the policy number?
[CUSTOMER][NEUTRAL] Policy number is 02498570.
[AGENT][NEUTRAL] And I get phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] OK, my callback number is [PII] and it's a direct line.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what is your name? Could you please spell that?
[AGENT][NEUTRAL] [PII] First initial last name is [PII], and you'll use my name in today's date as reference for today's call. What's the patient's name and date of birth, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Patient name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and you said you're checking a claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what's the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Data service is [PII] and the total amount is $554 even.
[AGENT][NEUTRAL] 554.
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] 6
[AGENT][NEUTRAL] OK, so there was no benefit made or payment made on this one because the maximum amount payable for this occurrence has been met.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Um, and that maximum amount.
[AGENT][NEUTRAL] Uh, the benefit is $1000 per occurrence, and that $1000 has been met for that, for that occurrence. Um, I show the claim was received.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Process [PII].
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] And let me know when you're ready for the claim number.
[CUSTOMER][NEUTRAL] Uh, it was processed on [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number
[CUSTOMER][NEUTRAL] Yes, I'm ready for the claim number.
[AGENT][NEUTRAL] It's 354-732-3.
[AGENT][NEUTRAL] And [PII], you can also check your status on our online service center at [PII], and did you have any other questions?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, yes, uh, may I know the last occurrence past date and last paid service for this member?
[AGENT][NEUTRAL] It's a claim that we received from a different provider which we cannot disclose.
[AGENT][NEGATIVE] So that benefit is exhausted.
[CUSTOMER][NEUTRAL] OK, so it's a patient responsibility, right?
[AGENT][NEUTRAL] We do not determine patients responsibility.
[AGENT][NEUTRAL] Just tell you that the benefit is exhausted.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the benefit is exhausted for uh could you please explain the denied reason one more time? I need to document it.
[AGENT][NEGATIVE] The per occurrence benefit for that service is exhausted.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, how many service uh is allowed for this patient for this?
[AGENT][NEUTRAL] It's a $1 maximum of $1000. It's $1 maximum of $1000.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] OK, and what is the last date of service?
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] OK, as I stated earlier, it's from a different provider and so we can't disclose that information just know that your claim was denied because the maximum benefit is already met.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much for this information, [PII]. Have a great day and bye for now.
[AGENT][NEUTRAL] Anything else?
[AGENT][POSITIVE] You're welcome. Thank you.
[CUSTOMER][POSITIVE] No, that's all for the day and thank you so much for asking.
[AGENT][POSITIVE] Thank you for thank you for calling APL.
[CUSTOMER][NEUTRAL] Bye bye.