AccountId: 011433970860
ContactId: c28d4b0d-30af-46c9-8a50-3168b50d34e3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 302859 ms
Total Talk Time (AGENT): 95306 ms
Total Talk Time (CUSTOMER): 146370 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/c28d4b0d-30af-46c9-8a50-3168b50d34e3_20250625T18:56_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Uh, hi, [PII]. This is [PII]. I'm calling from products office to check the claim status. How are you doing today?
[AGENT][NEUTRAL] Uh, fine. I can verify claim status for you, [PII], and what is the policy number, please?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, the policy number was.
[CUSTOMER][NEUTRAL] 025658666
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You said 02565866?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And call back number in case the call drops?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] 2012826179.
[AGENT][NEUTRAL] OK. And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] His name is uh [PII]. Uh date of birth was [PII].
[AGENT][NEUTRAL] OK, and what was today's service and amount of the charge?
[CUSTOMER][NEUTRAL] Uh, [PII], total charge was $3,948.
[AGENT][NEUTRAL] You mean [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Can't be [PII] since it hadn't came yet. So you see [PII], or you mean [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] There cannot be a [PII]. There can't be a this in June.
[CUSTOMER][NEUTRAL] Uh, I'm sorry. Uh, I'm sorry, sir.
[CUSTOMER][NEUTRAL] Uh, it's, it was [PII]. I'm sorry for that.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the balance after primary?
[CUSTOMER][NEUTRAL] Um, $597 even.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] You know.
[CUSTOMER][NEUTRAL] But again with.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the name of the provider's office?
[CUSTOMER][NEUTRAL] Hm, Baptist Hospital.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Uh, it was Kendall and Cesa Associates.
[AGENT][NEUTRAL] OK, I'm showing that claim process as the inpatient benefit has maxed for the calendar year.
[CUSTOMER][NEUTRAL] My.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It was denied, right?
[AGENT][NEUTRAL] Yes, the claim denied as the benefits of max for inpatient for the calendar year.
[CUSTOMER][NEUTRAL] OK. May I know the date?
[AGENT][NEUTRAL] Sure, uh, claim process on [PII] of this year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And received on?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And they are the same, right?
[CUSTOMER][NEUTRAL] Well.
[AGENT][NEUTRAL] Yes, inpatient benefit has max for the calendar year.
[CUSTOMER][NEUTRAL] OK. Uh, may I know the maximum benefits in terms of dollar value or visitor per visit?
[AGENT][NEUTRAL] In terms of dollars, uh, the patient had an inpatient benefit max of up to $8500 per calendar year. They've already met the max.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, $85 right? $8500.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Uh, he met all right.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] He was, he was met maximum, right?
[AGENT][NEUTRAL] Yes, they've met their max for the calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh, I especially made the allowed dollar amount excluding this claim, right?
[AGENT][NEUTRAL] Sir, is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Um, may I have the claim number?
[AGENT][NEUTRAL] 3600025
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Call this number.
[AGENT][NEUTRAL] You may use my name in today's day.
[CUSTOMER][NEUTRAL] Mhm. Kikire it, right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Mm thank you, [PII]. Thank you. Have a great day. Bye-bye.
[AGENT][POSITIVE] You're welcome, welcome. Thank you for calling APL. Bye.
[CUSTOMER][NEUTRAL] Yeah.