AccountId: 011433970860
ContactId: d015ac0c-3150-43c7-9bd9-2ed959bedc13
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 251919 ms
Total Talk Time (AGENT): 108737 ms
Total Talk Time (CUSTOMER): 93605 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/d015ac0c-3150-43c7-9bd9-2ed959bedc13_20250520T16:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, hi, this is [PII] calling from products office to check on a claim status.
[AGENT][NEUTRAL] OK, I could check on the client for you, uh, and can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sure it's going to be [PII] [PII].
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Sure, it's going to be 02570.
[CUSTOMER][NEUTRAL] 582
[AGENT][NEUTRAL] OK, and then do you uh what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Yeah. It's going to be [PII] [PII] The last name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that and what was the date of service for this client, please?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] It's going to be [PII] with the amount of $1,365 even.
[AGENT][NEUTRAL] OK, that was 314 of 2025 for $1,365.
[CUSTOMER][POSITIVE] Yeah, you are right.
[AGENT][NEUTRAL] OK and then and do you have the uh tax ID for this provider please?
[CUSTOMER][NEUTRAL] Sure, it's going to be 5925, I mean, sorry, [PII].
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and so we did receive this claim it looks like we were unable to pay a benefit as the inpatient benefit for this calendar year had been met.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Inpatient.
[CUSTOMER][NEUTRAL] Oh, the member is.
[AGENT][NEUTRAL] Yes, the inpatient benefit for this member for the calendar year had been met.
[CUSTOMER][NEUTRAL] M
[CUSTOMER][NEUTRAL] OK. May I know the amount?
[AGENT][NEUTRAL] Uh yes one moment let me get that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so on this policy and the inpatient and outpatient maximums are combined into one, so that total benefit maximum is $3000 per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and the 3000 is met, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] May I know the claim number?
[AGENT][NEUTRAL] This claim number is 358-0861.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And may I have the receive date for this one?
[AGENT][NEUTRAL] Yes, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, this claim was received [PII].
[AGENT][NEUTRAL] And it was processed on March, yes, [PII].
[CUSTOMER][NEUTRAL] OK, and the down.
[CUSTOMER][NEUTRAL] OK. And can you spell out your name for documentation purpose?
[AGENT][NEUTRAL] Sure, it's [PII]. And was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] Uh, I need the UB copy for this, uh, OK. Can you provide it to the fax number? Shall I provide the fax number for you?
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Yes please I'm ready when you are.
[CUSTOMER][NEUTRAL] It's going to be [PII] with the attention of my name, it's [PII], and may I know the turnaround time.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, I can go ahead and send that now. Uh, should get it within about 10 minutes or so. I'm gonna read that fax number back to you and make sure I heard that correctly. That was [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, alright, I will go ahead and get that sent now.
[CUSTOMER][POSITIVE] You are right.
[AGENT][NEUTRAL] Alright, was there anything else I could help you with?
[CUSTOMER][NEUTRAL] OK. And may I know the policy for this call? No.
[AGENT][NEUTRAL] Reference number would be my first name, last initial, and today's date so my last initial is A.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][POSITIVE] OK. Thank you for that and thank you for helping me today, [PII]. Bye-bye. Take care.
[AGENT][POSITIVE] Of course, thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] Bye bye.