AccountId: 011433970860
ContactId: d0675770-f524-4442-bbe5-8f4c02a1c22c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 545320 ms
Total Talk Time (AGENT): 137071 ms
Total Talk Time (CUSTOMER): 104126 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/d0675770-f524-4442-bbe5-8f4c02a1c22c_20250530T16:20_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, hello, this is [PII], um, calling on behalf of Bonsa Cos Hospitals, and I would like to check on a claim status, please.
[AGENT][NEUTRAL] Sure, I can help you with claim status, [PII]. Can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Uh yes, um, that would be uh [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the policy number, please?
[CUSTOMER][NEUTRAL] The policy number would be?
[CUSTOMER][NEUTRAL] Let me just one moment.
[CUSTOMER][NEUTRAL] Uh, policy number is 0248.
[CUSTOMER][NEUTRAL] 1710.
[AGENT][NEUTRAL] OK, give me just a moment to look that up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] Um, yes, um, his name is [PII], and date of birth would be [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] And do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] I have the date of service.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, that would be [PII].
[AGENT][NEUTRAL] OK, give me just a moment to look that up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you know what the total build amount was?
[CUSTOMER][NEUTRAL] Um, yes, uh, $44.
[AGENT][NEUTRAL] OK, give me just a moment.
[AGENT][NEUTRAL] OK, I'm showing that we received that claim on [PII].
[AGENT][NEUTRAL] It was processed on the same day, [PII].
[AGENT][NEUTRAL] The claim number is 35.
[AGENT][NEUTRAL] 91.
[AGENT][NEUTRAL] 713.
[AGENT][NEGATIVE] And it looks like this was denied.
[AGENT][NEGATIVE] Due to the maximum benefit for the sickness writer has been exhausted for the calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, perfect. Um, uh, maybe what would you say it would be the best way to like, uh, continue with this claiming here?
[AGENT][NEUTRAL] Um, you wanna do another claim or I'm sorry, I don't understand. I apologize.
[CUSTOMER][NEUTRAL] Uh, yes, you told me that if this was denied uh because of the maximum benefit.
[AGENT][NEUTRAL] Yes, they've maxed out their benefits for the calendar year.
[CUSTOMER][NEUTRAL] OK. Oh, OK.
[AGENT][NEUTRAL] Yeah, it looks like they have um a max a maximum number of visits, 5 per adult, uh 10 combined, and so it looks like they've exhausted that with this.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect thank you very much for this information. Maybe um do you have like a space for another claim?
[AGENT][NEUTRAL] OK. Another claim with this patient or another patient?
[CUSTOMER][NEUTRAL] Uh it's a different patient.
[AGENT][NEUTRAL] OK, give me just one moment. Let me close out the notes on this patient, and I can help you with that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and do you have the next um
[AGENT][NEUTRAL] Policy number?
[CUSTOMER][NEUTRAL] Oh yes, allow me just a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, policy number would be 023.
[CUSTOMER][NEUTRAL] 343-72.
[AGENT][NEUTRAL] OK, let me look that up.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, yes. Her name is [PII].
[CUSTOMER][NEUTRAL] And date of birth would be [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And the date of service?
[CUSTOMER][NEUTRAL] Date of service, [PII].
[AGENT][NEUTRAL] OK, give me just a moment.
[AGENT][NEUTRAL] And do you have the total bill amount?
[CUSTOMER][NEUTRAL] Um, yes.
[CUSTOMER][NEUTRAL] That will be $256.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] It looks like we received this claim on [PII]. It was processed on [PII]. The claim number is 35.
[AGENT][NEUTRAL] 96105.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it looks like this claim was denied because office visits aren't covered under this policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there anything else I can help you with?
[CUSTOMER][POSITIVE] OK, perfect. Thank you very much for all that information.
[CUSTOMER][NEUTRAL] Um, no, that would be all. Thank you very much. Um, maybe, um, can you please provide me with a reference number for the call?
[AGENT][NEUTRAL] So we don't have reference numbers, but you can use my name and today's date. So [PII], last initial [PII] and today's date.
[CUSTOMER][POSITIVE] Perfect. Thank you very much for all that information.
[AGENT][POSITIVE] OK. Thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye.