AccountId: 011433970860
ContactId: af0f801f-e98b-4417-b03b-a1238553d7dd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 627700 ms
Total Talk Time (AGENT): 169097 ms
Total Talk Time (CUSTOMER): 163718 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/af0f801f-e98b-4417-b03b-a1238553d7dd_20250324T12:31_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, how you doing? I'm sorry I didn't get your name.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Hey, Ms. [PII], how are you doing this morning?
[AGENT][POSITIVE] I'm good good how are you?
[CUSTOMER][POSITIVE] Good, I'm just giving you guys a call um.
[CUSTOMER][NEUTRAL] In reference to
[CUSTOMER][NEUTRAL] Claim status, I was hoping I could get today.
[AGENT][NEUTRAL] OK, and your name?
[CUSTOMER][NEUTRAL] My name is [PII], last initial [PII], my last name.
[AGENT][NEUTRAL] [PII] or [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, spell your first name?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and I'm sorry, did you say you're calling for benefits or claim status?
[CUSTOMER][NEUTRAL] Claim status.
[AGENT][NEUTRAL] OK, and the policy number and a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes ma'am, the policy number I'm seeing is 0240.
[CUSTOMER][NEUTRAL] 7896
[CUSTOMER][NEUTRAL] M as in Mary.
[CUSTOMER][NEUTRAL] L as in Lima.
[CUSTOMER][NEUTRAL] Number 7.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And a good call back number is gonna be [PII].
[CUSTOMER][NEUTRAL] 995
[CUSTOMER][NEUTRAL] 9105.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Her name and date of birth is Miss [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] So I'm showing a different policy number, the one you gave me termed [PII], uh, the current policy number which actually is termed as well, but it's 254-4387.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Uh, this policy became effective [PII] and no longer active as of [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Packaging got you.
[AGENT][NEGATIVE] So, no active coverage.
[AGENT][NEUTRAL] Hold on one second.
[CUSTOMER][NEUTRAL] I was gonna say I have an active data service. I was gonna see if you can look into for me.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] What policy number did I give you?
[CUSTOMER][NEUTRAL] You gave me the 254-438-87.
[AGENT][NEUTRAL] I'm sorry, it's 987.
[AGENT][NEUTRAL] 254-498-87 mhm and what is the date of service?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] The data service I'm seeing is 821 or 24.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] So that falls up under the, the one that you gave me, got it.
[AGENT][NEUTRAL] The initial one that you gave me.
[CUSTOMER][NEUTRAL] Got you. OK, so she was active at the time. Gotcha. OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] So you said it's [PII].
[CUSTOMER][NEUTRAL] The [PII], the day of service.
[AGENT][NEUTRAL] And what was it, what was the total charge?
[CUSTOMER][NEUTRAL] It was 895.
[AGENT][NEUTRAL] And is it a professional fee or facility charge?
[AGENT][NEUTRAL] And inpatient or outpatient?
[CUSTOMER][POSITIVE] It's professional.
[AGENT][NEUTRAL] Is it ambulance?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 1 2nd.
[CUSTOMER][POSITIVE] No, you're fine, take your time.
[AGENT][NEUTRAL] OK, so this claim process [PII], um, under this policy, the maximum outpatient benefit is uh $500 per calendar day and so this uh claim was not payable because the maximum benefit, the maximum daily benefit was exhausted.
[AGENT][NEUTRAL] Um, it processed under claim number 354.
[AGENT][NEUTRAL] 0015.
[CUSTOMER][NEUTRAL] 0015
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][POSITIVE] Thank you for that.
[AGENT][NEUTRAL] Any other questions?
[CUSTOMER][NEUTRAL] Um, well, yes, ma'am, while I have you, can I get you looking into somebody else for me or would I have to?
[AGENT][NEUTRAL] A diff a different patient?
[CUSTOMER][NEUTRAL] Yes ma'am, but are there any reference number for this call or would it be like for individual patients or is it for the entire call?
[AGENT][POSITIVE] Mhm you'll use my name in today's date for the call for the entire call.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] [PII]. You're welcome. And then the first initial last name is [PII] and today's date.
[CUSTOMER][POSITIVE] Perfect. Thank you for that.
[CUSTOMER][POSITIVE] Sounds good. Alright, and you say you will be able to look at somebody else for me?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm we document this one and we can proceed.
[CUSTOMER][POSITIVE] Sounds good to me.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alright, I'm ready for the next policy number.
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] We have 02.
[CUSTOMER][NEUTRAL] 33
[CUSTOMER][NEUTRAL] 59
[CUSTOMER][NEUTRAL] 00
[CUSTOMER][NEUTRAL] M as in Mary. L as in Lima, the number 8.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] [PII] verify the patient's name and date of birth for me?
[CUSTOMER][NEUTRAL] I sure can. We have Mr. [PII].
[CUSTOMER][NEUTRAL] I believe and his date of birth is showing [PII].
[AGENT][NEUTRAL] OK, and what is the claim status for [PII]?
[AGENT][NEUTRAL] The data service mhm.
[CUSTOMER][NEUTRAL] Yes, I'm look.
[CUSTOMER][NEUTRAL] It's gonna be
[CUSTOMER][NEUTRAL] I'm sorry, 822 2024.
[AGENT][NEUTRAL] And the charge?
[CUSTOMER][NEUTRAL] I'm seeing the charge be 8:35.
[AGENT][POSITIVE] Thank you for that.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] And you said that the patient's name is [PII], correct? Date of birth [PII]?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yes ma'am, that's right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so under this policy, the maximum benefit was exhausted, um, so no, uh, payment was made on this one it was processed under claim number 354.
[AGENT][NEUTRAL] 5016.
[CUSTOMER][NEUTRAL] OK, you said the max is exhausted on this patient as well.
[AGENT][POSITIVE] Correct, the outpatient benefit maximum.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty.
[AGENT][NEUTRAL] Alright any other questions Miss [PII]?
[CUSTOMER][POSITIVE] I know you said the reference for this call was your name in today's date, but as of now it looks like I'm good. Thank you for all your help today, Miss [PII]. I really appreciate it.
[AGENT][POSITIVE] You're welcome, [PII]. Thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too.