AccountId: 011433970860
ContactId: c45d9426-39b0-40a3-b677-82fa0d4a5e9a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 158199 ms
Total Talk Time (AGENT): 32670 ms
Total Talk Time (CUSTOMER): 68666 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/c45d9426-39b0-40a3-b677-82fa0d4a5e9a_20250414T14:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh, hey, [PII], [PII] from Orthopedic Anesthesia pain specialist. Uh, I'd like to go over a denial that we received on a mutual patient.
[AGENT][NEUTRAL] OK. Can I get your name and a good callback number?
[CUSTOMER][NEUTRAL] Yeah, uh, [PII], and [PII].
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Yes, uh, it is.
[CUSTOMER][NEUTRAL] 02036914ML8
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII], [PII].
[AGENT][NEUTRAL] And what was that date of service?
[CUSTOMER][NEUTRAL] Uh [PII].
[CUSTOMER][NEUTRAL] Aha.
[AGENT][NEUTRAL] OK, let's see
[AGENT][NEUTRAL] OK, looks like we had denied it for maximum benefit payable for data service has been met.
[CUSTOMER][POSITIVE] Um maximum faster.
[CUSTOMER][NEUTRAL] OK. Alright, leaving the member responsible for the balance, uh, and you did have the primary EOP correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So he'll get confirmation and he'll be showing he owes 25308.
[AGENT][NEUTRAL] Uh, well, we don't put anything about patient responsibility we just simply process the claim because we're secondary.
[CUSTOMER][NEUTRAL] OK, but being that you're not processing because the maximum benefit was reached.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] That it will specify that, yeah.
[CUSTOMER][NEUTRAL] You would be aware of that.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] He'll be aware of that, OK.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] All right. And it's [PII], correct? [PII]?
[AGENT][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] Your first name? Oh.
[CUSTOMER][NEUTRAL] OK, [PII] Any reference number?
[AGENT][NEUTRAL] Uh, just my name and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you very much. Have a good day.
[AGENT][POSITIVE] Thank you for calling APLU as well.
[CUSTOMER][POSITIVE] Thank you bye thanks bye.