AccountId: 011433970860
ContactId: bcbddcac-c0e1-4390-a923-35a7fa4602c5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 249279 ms
Total Talk Time (AGENT): 113753 ms
Total Talk Time (CUSTOMER): 98068 ms
Interruptions: 1
Overall Sentiment: AGENT=1.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/bcbddcac-c0e1-4390-a923-35a7fa4602c5_20250312T18:42_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, yeah. This is [PII] calling from Pros office any of the claim status?
[AGENT][NEUTRAL] OK, yeah, I can check on a claim for you. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. The callback number is going to be [PII] with the extension of [PII].
[CUSTOMER][NEUTRAL] Would you please spell out your name for me once?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Sure, it's [PII]
[CUSTOMER][POSITIVE] [PII]. OK. Thanks so much, [PII].
[AGENT][NEUTRAL] Yes, of course. And did you have that policy number?
[CUSTOMER][NEUTRAL] Yes, I do have. So the policy number is going to be, it's 246-0355.
[AGENT][NEUTRAL] OK, and uh what was the name and date of birth for the insured, please?
[CUSTOMER][NEUTRAL] Yeah, name of the member is [PII], and the date of birth is [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that [PII] uh what was the date of service for this claim, please?
[CUSTOMER][NEUTRAL] Yeah, date of service is [PII] with the total bill charge of $4,065 even.
[AGENT][POSITIVE] OK, thank you one moment please.
[CUSTOMER][POSITIVE] Sure, can. Take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so we did receive this claim, [PII], we were unable to pay a benefit as their outpatient benefit for the calendar year had been met.
[CUSTOMER][NEUTRAL] The outpatient benefits has been met, right, for the calendar year.
[AGENT][POSITIVE] Correct. Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, may I know what's the claim received?
[AGENT][NEUTRAL] Yes, so this claim was received.
[CUSTOMER][NEUTRAL] And when it was
[AGENT][NEUTRAL] Absolutely, um, this was received [PII] and it was processed [PII].
[CUSTOMER][NEUTRAL] OK. Do you have the claim number?
[AGENT][NEUTRAL] That is 3552289.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 389. OK.
[CUSTOMER][POSITIVE] Thank you so much. So,
[CUSTOMER][NEUTRAL] May I know how much uh the uh like patient have been for the calendar year? How many visits with the patient have?
[AGENT][NEUTRAL] Sure, they're outpatient benefit. Yes, give me just a moment. So it is no longer active, um, but let me see how much that was.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, OK.
[AGENT][NEUTRAL] OK, so, um, that calendar year maximum was $3500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So he, he made like $500 right?
[AGENT][NEUTRAL] Yes, so he had used all of that benefit amount uh prior to this claim.
[CUSTOMER][NEUTRAL] Prior to this claim, OK.
[AGENT][NEUTRAL] Yes, and if you'd like [PII], I can send you a copy of this EOB.
[CUSTOMER][NEUTRAL] Yeah, OK, please go ahead and send the copy of your I'll provide the fax number to you. Yeah.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, the so, when you're ready, tell me, I'll give the fax number.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] I'm ready when you are.
[CUSTOMER][NEUTRAL] Yeah, uh, the fax number is going to be, it's [PII].
[AGENT][NEUTRAL] OK, I'm gonna read that back to make sure I heard that correctly. That was [PII].
[CUSTOMER][NEUTRAL] Yes, you are currently.
[AGENT][POSITIVE] OK, I will get that sent to you. I should get it here within 10 to 15 minutes. Uh, was there anything else I could help you with?
[CUSTOMER][NEUTRAL] Yeah, uh,
[CUSTOMER][NEUTRAL] Yeah, that's it from my end. So may I know the call number before I end the call?
[AGENT][NEUTRAL] Sure, yes, that would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII]
[CUSTOMER][POSITIVE] OK, yeah. Thanks so much for choosing this claim, care. You have a great day.
[AGENT][NEUTRAL] Of course.
[AGENT][POSITIVE] You are very welcome. Thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] Yeah, bye-bye. Bye-bye.