AccountId: 011433970860
ContactId: bc81c9c3-5f93-44b6-822f-071309d34cf5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 317940 ms
Total Talk Time (AGENT): 59900 ms
Total Talk Time (CUSTOMER): 99882 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/bc81c9c3-5f93-44b6-822f-071309d34cf5_20250328T20:34_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi, [PII]. I'm [PII] calling from provider's office regarding our claims.
[AGENT][NEUTRAL] OK, needing claim status, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] You have a good callback number?
[CUSTOMER][NEUTRAL] [PII] with the extension of [PII].
[AGENT][NEUTRAL] And do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Pres policy number is 01896036 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Uh member's first name is going to be [PII] and the last name is [PII], and the date of birth is this uh [PII].
[AGENT][POSITIVE] Thank
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is that date of service?
[CUSTOMER][NEUTRAL] Sure, the date of service is going to be, it's uh [PII]. mhm with the bill amount of $2610 a month.
[AGENT][NEUTRAL] OK, let me get that pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, the outpatient benefit for the calendar year was met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] The outpatient benefit has been met for the calendar year under this policy?
[CUSTOMER][NEUTRAL] You're stating that maximum benefits have been adjusted, right?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] You're stating that the uh maximum benefits have been adjusted as outpatient benefits have been met as per calendar year, am I right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEGATIVE] No, no, as per dollar amount or as per the visits, it was been exhausted.
[AGENT][NEUTRAL] Um, let me look it up. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, the benefit is 500.
[CUSTOMER][NEUTRAL] OK, you're saying that as per dollar amount, the maximum benefits been exhaustion, right.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Just give me a second.
[CUSTOMER][NEUTRAL] OK, may I know, uh, like, uh.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Do you have any information like, uh, under which claim previously under which claim the maximum benefits have been the dollar amount has been met?
[AGENT][NEUTRAL] No, I, I would just be able to give you the claim status for this particular claim.
[CUSTOMER][NEUTRAL] OK, got it. I do understand. OK. Could you please help me with the claim number?
[AGENT][NEUTRAL] Claim number is 3506454.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] On call you uh can you send me the copy of your fax deary.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What's your fax number?
[CUSTOMER][NEUTRAL] 615
[CUSTOMER][NEUTRAL] 777
[CUSTOMER][NEUTRAL] 3536
[AGENT][NEUTRAL] And put it to your attention.
[CUSTOMER][NEUTRAL] Can I attention to my name, [PII]
[AGENT][NEUTRAL] Is that [PII]?
[CUSTOMER][NEUTRAL] [PII] yeah.
[AGENT][NEUTRAL] OK, I can get that faxed over for you. Did you have any other claims to check on today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Nothing else. And those, may I know the initial last name [PII]?
[AGENT][NEUTRAL] Uh, last initial is [PII].
[CUSTOMER][NEUTRAL] OK, could you please help me the call reference for this claim.
[AGENT][NEUTRAL] Uh, just be my first name, [PII], last initial [PII], and then today's date.
[CUSTOMER][POSITIVE] Thank you, [PII]. That's it all the information I need.
[CUSTOMER][POSITIVE] And thank you for assistance. Mhm.
[AGENT][POSITIVE] OK, thanks for calling APL. Have a good weekend.
[CUSTOMER][NEUTRAL] You too. Bye for now.
[AGENT][NEUTRAL] But