AccountId: 011433970860
ContactId: c8d390c2-049f-4b79-bc1f-1df32480f56a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 446179 ms
Total Talk Time (AGENT): 123795 ms
Total Talk Time (CUSTOMER): 212407 ms
Interruptions: 8
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/c8d390c2-049f-4b79-bc1f-1df32480f56a_20250325T17:49_UTC.wav
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[CUSTOMER][NEUTRAL] So this
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider's office to check up on the claim status.
[AGENT][NEUTRAL] OK, I can assist you. Can you spell your first name for me, please?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[CUSTOMER][NEUTRAL] It.
[AGENT][NEUTRAL] It's pronounced, is it [PII]?
[CUSTOMER][NEUTRAL] LT
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Spell it again for me, please.
[AGENT][NEUTRAL] [PII], OK. And what's the policy number and a good phone number, [PII]?
[CUSTOMER][NEUTRAL] Yes, policy number, it is 02458526.
[AGENT][NEUTRAL] And what's a good phone number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you. You can also check claim status online at [PII], and I can help you set that account up if you would like. Can you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, patient's name, it is [PII], and the date of birth it is [PII].
[AGENT][NEUTRAL] Thanks for that information, [PII] and we're checking claim status for what date of service?
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] [PII] but the bill amount of $667 even.
[AGENT][NEUTRAL] I'm sorry, I didn't get the date of service could you repeat please?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I want to know about it.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Ma.
[AGENT][NEUTRAL] Alright, so I showed this claim was processed [PII]. Uh, no payment was made, um, as the maximum outpatient benefit is exhausted.
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hey, did you hear me?
[CUSTOMER][NEUTRAL] Yes, I heard it outpatient benefits has been exhausted, right?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. May I know the how many benefits does patient have?
[AGENT][NEUTRAL] It's $1 maximum of up to $3000 per calendar year.
[CUSTOMER][NEUTRAL] $43.
[AGENT][NEUTRAL] A maximum of up to $3000 per calendar year.
[CUSTOMER][NEUTRAL] Sending that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And when was it was, when it was exhausted?
[AGENT][NEGATIVE] It was an exhausted with another provider's claim.
[CUSTOMER][NEUTRAL] You know, you know.
[AGENT][NEUTRAL] In [PII].
[CUSTOMER][NEUTRAL] OK, can I know the date?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Have the date of service on which date it was exhausted.
[AGENT][NEUTRAL] Give me one moment please, I'm looking through the claim history.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, take your time.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Oh man.
[AGENT][NEUTRAL] Uh, it was exhausted [PII].
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEGATIVE] No. OK.
[CUSTOMER][NEUTRAL] OK then for the same. I have one mode of service.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Can I have the claim number also for this date of service one minute. Can I have the received date and the claim number?
[AGENT][NEUTRAL] OK, give me one.
[AGENT][NEUTRAL] Give me one moment. It was received on the [PII] and hold for just a second.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We.
[AGENT][NEUTRAL] The claim number is 355-033-1.
[AGENT][NEUTRAL] And what is the other date of service?
[CUSTOMER][NEUTRAL] Yes, so this [PII] with the amount of $667 even.
[AGENT][NEUTRAL] OK, that denied for the same reason under under claim number 355-0333.
[AGENT][NEUTRAL] Showing a received date.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Showing a received date of [PII] process date of [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] He
[CUSTOMER][NEUTRAL] OK, for the previous date of service I received and the process data is same right.
[AGENT][NEUTRAL] What dates did I give you?
[CUSTOMER][NEUTRAL] This, uh, [PII] for the receipt in the process.
[AGENT][NEUTRAL] Received was [PII], processed [PII].
[CUSTOMER][NEUTRAL] For the date of service of [PII] also.
[AGENT][NEUTRAL] Same date received date and same process date.
[AGENT][NEUTRAL] For about
[CUSTOMER][POSITIVE] OK, then thank you.
[CUSTOMER][NEUTRAL] OK, thank you and uh can I have the, could you please spell out your name and can I have the call reference number.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You'll use my name in today's date as reference for today's call [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] First initial last name is [PII], and anything else I can help out with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, that's it thank you have a nice day.
[AGENT][POSITIVE] Hey, you're welcome, [PII]. Thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Monday.