AccountId: 011433970860
ContactId: c8c9d2a3-80a6-4df1-9913-00e9c76d5809
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 188720 ms
Total Talk Time (AGENT): 76176 ms
Total Talk Time (CUSTOMER): 81523 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/c8c9d2a3-80a6-4df1-9913-00e9c76d5809_20250317T15:04_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, yes, my name is [PII], and I am needing to check on an old claim.
[AGENT][NEUTRAL] I'm sure, [PII], I can assist you with claim status. Um, first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. Now, I need the policy number, please.
[CUSTOMER][NEUTRAL] 02150746
[AGENT][NEUTRAL] OK, thank you. Now, please verify your date of birth and your mailing address.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And please verify your email address.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Please verify your email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. Um, and what's the date of service and bill charges for the claim you're calling about?
[CUSTOMER][NEUTRAL] The date of service [PII].
[CUSTOMER][NEUTRAL] Through [PII].
[AGENT][NEUTRAL] OK. Is this for the hospital client?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, yes, ma'am. I'm showing that this claim um denied because under your policy for inpatient benefits, let's see, we cover up to 2500 per calendar year and that benefit maxed out on previous claims.
[CUSTOMER][NEUTRAL] From previous claims of the 2024 year.
[AGENT][NEUTRAL] For the
[AGENT][NEUTRAL] Yes, ma'am. Previous hospital claims. Um, we received the claims for the anesthesia first and that one paid out and we received um other claims for physician charges, and those paid out as well and that maxed out the 2500 for the calendar year.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, alright, alright, well that makes a lot of sense, thank you very much and um and just uh I don't know if you need to, if this needs to be included in the notes as well but um I had spoken with my primary insurance which is EBMS and um so they actually took um y'all's information.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, so that way they could coordinate between the two. I didn't realize that they needed my secondary insurance so that it would make things easier, um, so I, I just wanted to let someone know from APL.
[AGENT][NEUTRAL] OK. Yes, ma'am. And I'll make a note of that.
[CUSTOMER][POSITIVE] OK, alright, thank you so much.
[AGENT][NEUTRAL] OK. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] That's all.
[AGENT][POSITIVE] OK. Well, I thank you again, [PII] for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Mm