AccountId: 011433970860
ContactId: ba07b10a-6c6b-41c1-990b-54c806801cef
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 192860 ms
Total Talk Time (AGENT): 80235 ms
Total Talk Time (CUSTOMER): 48769 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/ba07b10a-6c6b-41c1-990b-54c806801cef_20250114T15:48_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. I'm calling from Med Health to check on a claim.
[CUSTOMER][NEUTRAL] And I'm sorry, what was your name?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] Right, see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII], may I please have a callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes ma'am, it's [PII], that is correct.
[AGENT][NEUTRAL] OK, and you needed a claim status?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] May I please have the policy certificate or member ID please?
[CUSTOMER][NEUTRAL] Um, 024139997.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And just give me one moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And may I please have you verify patient's name and their date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And what is the data service and the amount on the place please?
[CUSTOMER][NEUTRAL] [PII] $1,717.79.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Just give me one moment to search claims please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I do show that claim was received [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim number 35.
[AGENT][NEUTRAL] 43.
[AGENT][NEUTRAL] 333.
[AGENT][NEUTRAL] Uh, the claim was processed on [PII].
[AGENT][NEGATIVE] And it was denied due to the max was met for that data service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it looks like these are facility charges. It looks like the benefit was paid um under the professional fee for that same data service of 12-15-2023.
[AGENT][NEUTRAL] This policy is limited medical hospital indemnity, so it does have limited medical benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] So there was no additional benefit allowed for that data service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] Did you have any other questions [PII]?
[CUSTOMER][POSITIVE] No, that's all I appreciate your help.
[AGENT][POSITIVE] You're welcome thank you for calling APL and I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too, bye bye.
[AGENT][POSITIVE] Thank you Toy bye bye.