AccountId: 011433970860
ContactId: a90a2d58-ab7f-4b00-bc6a-7f1cdcb116ad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 273339 ms
Total Talk Time (AGENT): 110272 ms
Total Talk Time (CUSTOMER): 90410 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/a90a2d58-ab7f-4b00-bc6a-7f1cdcb116ad_20250103T16:08_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. My last name is [PII] for [PII], calling behalf of provider's office to check the claim status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status in case this call is disconnected. May I have your callback number?
[CUSTOMER][NEUTRAL] Yeah it's [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 02273083.
[AGENT][NEUTRAL] Thank you. And it was 02273083?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you. And may I have the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] The patient is Indian like [PII]
[CUSTOMER][NEUTRAL] And the last name is [PII]
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][NEUTRAL] Thank you. And may I have the date of service and the bill amount of the claim?
[CUSTOMER][NEUTRAL] Yeah [PII] with the charge amount of $2820 even.
[AGENT][NEUTRAL] Thank you, and that's for a date of service of [PII] for $2820?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] OK, I show we did receive that claim in it was received on [PII] and processed on [PII]. I showed the max has already been met for this data service. Therefore, no benefits are payable. They've already exhausted their max benefit payable for this data service. Would you like the claim number?
[CUSTOMER][NEUTRAL] Once again, what is the issue date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] What is the process date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And uh dinner for.
[AGENT][NEUTRAL] The maximum benefit payable for this data service has been met.
[CUSTOMER][POSITIVE] Maximum benefit.
[CUSTOMER][NEUTRAL] On that visit the plan or uh visit plan?
[AGENT][NEUTRAL] Under this plan, they've already met their max for this data service.
[CUSTOMER][NEUTRAL] I mean, uh, under the dollar plan or uh in the visit plan?
[AGENT][NEUTRAL] Under their coverage with us, we're secondary.
[CUSTOMER][NEUTRAL] You're secondary.
[CUSTOMER][NEUTRAL] Yeah, OK. I have another, uh, for the same in the medical records, uh, the, it is showing, uh, another member ID. Can you check, uh, is it, uh, active on this, for this patient?
[AGENT][NEUTRAL] Yes, the coverage is currently active, effective [PII].
[CUSTOMER][NEUTRAL] No [PII]. OK.
[CUSTOMER][NEUTRAL] And I mean, uh, I'm asking about uh uh it has been already met, but how it has been met, like, uh, in the, on the dollar planner, uh, number of visit plan, how much it will
[AGENT][NEGATIVE] It's already been met. We've received a previous claims from a different provider for the same data service. The plan only covers a maximum benefit for per data service. The policy only covers a maximum of $1000 per calendar day. So they've already exhausted their maximum benefit for this same data service from previous providers. Therefore, no benefit is payable.
[CUSTOMER][NEUTRAL] OK. Can I know the date when it has been last met?
[AGENT][NEUTRAL] I can't provide that information to you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I can provide you with the claim number regarding this particular claim.
[AGENT][NEUTRAL] But it was met in [PII].
[CUSTOMER][NEUTRAL] Yeah, can I get the
[CUSTOMER][NEUTRAL] Yeah, can I have the claim number?
[AGENT][NEUTRAL] The claim number is 353-6771.
[CUSTOMER][NEUTRAL] Yeah, got it. Can I get the call reference number, [PII]?
[AGENT][NEUTRAL] It'll be just my name and that's [PII] [PII] Is there anything else I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Uh, no, no. I think that's it from my end.
[AGENT][POSITIVE] OK, well thanks for calling APO you have a good day.
[CUSTOMER][NEUTRAL] Yeah bye bye.
[AGENT][POSITIVE] Thanks, bye.