AccountId: 011433970860
ContactId: ccb92004-ebd1-4091-8440-d10a413bdebf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 240809 ms
Total Talk Time (AGENT): 80622 ms
Total Talk Time (CUSTOMER): 87389 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/ccb92004-ebd1-4091-8440-d10a413bdebf_20250318T15:36_UTC.wav
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[AGENT][NEUTRAL] [PII], this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey, I need to check on the remaining benefits for a patient, please.
[AGENT][NEUTRAL] Sure, I could assist you with that. Can I have your name and a callback number?
[CUSTOMER][NEUTRAL] My name is [PII]. The callback number is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. What is that member's policy number?
[CUSTOMER][NEUTRAL] Um, the policy number.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] It's under her mom.
[CUSTOMER][NEUTRAL] And the policy number is 02564042.
[AGENT][NEUTRAL] Uh, could you verify that patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name is [PII].
[CUSTOMER][NEUTRAL] And that birthday is [PII].
[AGENT][NEUTRAL] Thank you, and you're calling to verify the benefits used for [PII]?
[CUSTOMER][NEUTRAL] Yeah, I need to know how many she has remaining.
[AGENT][NEUTRAL] She has not utilized any of her benefits for [PII]. However, she does have a claim that's currently waiting to be waiting to be processed, but it has not been processed, so as of today, she has not utilized any of her benefits for [PII].
[CUSTOMER][NEUTRAL] OK, is that claim um for our office?
[CUSTOMER][NEUTRAL] That you see Newberry.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Or is it Columbia periodontal?
[AGENT][NEUTRAL] Give me a moment while I look that up.
[CUSTOMER][NEUTRAL] Is that in the garments. I'm sorry.
[AGENT][NEUTRAL] What is the name of your physician's office?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEGATIVE] No, it's not for you, it's not for you, it's for orthodontics.
[CUSTOMER][NEUTRAL] OK, OK, so can, what is the claims address for because I've sent the claim.
[CUSTOMER][NEUTRAL] But if it's not showing up, I'm wondering.
[CUSTOMER][NEUTRAL] If we don't have the right.
[AGENT][NEUTRAL] The claims address will be addressed to.
[AGENT][NEUTRAL] APL claims department.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]. That's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, that's the same address I have in there. I'll just try resubmitting the claim on our end and see if.
[AGENT][NEUTRAL] Do you have the payer ID?
[CUSTOMER][NEUTRAL] Um, let me see, let me just pull back up. I'm sorry.
[AGENT][NEUTRAL] And could you provide me with the spelling of your name?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Um, the payer ID I have is 60801.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, yeah, that's weird. OK, I'll just resend it. I'll get it mailed back in.
[AGENT][NEUTRAL] Alright, is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] It's $70,000.
[CUSTOMER][NEUTRAL] Is her max $1000?
[AGENT][NEUTRAL] No, ma'am, her policy benefit amount is $500 per calendar year with a $50 deductible per insured up to $150 per family, and this is not a guaranteed benefit, it's just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Sure, right, right, that sounds good. Thank you so much for your help.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL How do you have a great day.
[CUSTOMER][NEUTRAL] You bye bye.
[AGENT][POSITIVE] Thanks, goodbye.