AccountId: 011433970860
ContactId: b1b894f5-7966-43f7-bf5d-be8b4c241042
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 167419 ms
Total Talk Time (AGENT): 92167 ms
Total Talk Time (CUSTOMER): 37729 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/b1b894f5-7966-43f7-bf5d-be8b4c241042_20250304T21:22_UTC.wav
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[AGENT][NEUTRAL] For contacting APL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], and I'm needing claim status for a patient, please.
[AGENT][NEUTRAL] I can help with the claim status, [PII] what is that policy number, please?
[CUSTOMER][NEUTRAL] Let's take a look. It is 02462791.
[AGENT][NEUTRAL] Thank you, and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you. I just need a callback number, please, in the event that we're disconnected.
[CUSTOMER][NEUTRAL] It is gonna be [PII].
[AGENT][NEUTRAL] Thank you. What date of service were we looking for for [PII]?
[CUSTOMER][NEUTRAL] [PII] the billed amount is $1,779.90.
[AGENT][NEUTRAL] Thank you. It looks like your claim number.
[AGENT][NEUTRAL] It's 356-582-3.
[AGENT][NEUTRAL] And it looks like we received that claim.
[AGENT][NEUTRAL] On the uh.
[AGENT][NEUTRAL] [PII], we processed it on the [PII].
[AGENT][NEGATIVE] And now that was denied um.
[AGENT][NEUTRAL] Uh, because, uh,
[AGENT][NEUTRAL] So the policy has a family maximum, maximum benefit that uh once reached, uh, none of the other claims will be paid, that's $4000 per calendar year. Once that amount has been reached, then um,
[AGENT][NEUTRAL] And the this those benefits are are exhausted, so that had been reached by the time we received your claim, and that's why it was not paid.
[CUSTOMER][NEUTRAL] OK, so will the patient be responsible for this amount?
[AGENT][NEUTRAL] Well, I can't tell you that they are responsible. The only thing I can tell you is that um uh that this policy is the benefits for that year are exhausted. Uh, now, it could end up being that they have another policy. Sometimes, uh sometimes they do. So I, I, I would certainly refer you back to the insured, but I don't know whether they're going to owe it or not. Um.
[AGENT][NEGATIVE] They may have another policy as I said, but this one is exhausted for that calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK. Can I get a reference number for this call, please?
[AGENT][NEUTRAL] Yes, my name is [PII]. The first letter of my last name is [PII], and we're gonna use that today's date as a reference. Is there anything else at all I can help with?
[CUSTOMER][POSITIVE] No, that'll be it. Thank you so much.
[AGENT][POSITIVE] Thanks for contacting HP