AccountId: 011433970860
ContactId: d128fb5c-2cb7-4210-b1b6-345bf97d1c96
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 193199 ms
Total Talk Time (AGENT): 90030 ms
Total Talk Time (CUSTOMER): 56042 ms
Interruptions: 0
Overall Sentiment: AGENT=2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/d128fb5c-2cb7-4210-b1b6-345bf97d1c96_20250122T15:59_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Good morning [PII]. My name is [PII]. I'm with the Holston Valley Medical Center. I need to check on the status of a medical claim, please.
[AGENT][POSITIVE] Oh, I'd love to help you with that, Ms. [PII]. Give me one second, and what's a great callback number for you?
[CUSTOMER][NEUTRAL] Direct line [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] 02510281
[AGENT][NEUTRAL] 02510281 did I get that correct?
[CUSTOMER][NEUTRAL] 02510. Yes.
[AGENT][POSITIVE] Thank you, I appreciate that and your member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Wonderful. Thank you very much.
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] The date of service for the claim we want to look for today?
[CUSTOMER][NEUTRAL] [PII] total charges $27,0007.17.
[AGENT][POSITIVE] OK, perfect. I believe I found it.
[AGENT][NEUTRAL] All right, and I know you said this when you introduced yourself, I'm sorry, but would you be able to reverify the name of the facility on file for that claim?
[CUSTOMER][NEUTRAL] Yes, Holston Valley Medical Center, you may have it as Wilmont.
[AGENT][POSITIVE] OK, perfect. Thank you so much.
[AGENT][NEUTRAL] All right, so I do see your claim here. It looks like we received your claim on [PII], and it was processed the same day, [PII].
[AGENT][NEUTRAL] I have your claim number listed as 3546932.
[AGENT][NEUTRAL] And I do show that this claim was denied. The reason stating is that the calendar year maximum for the accident and sickness surgical benefit performed in a hospital, hospital outpatient facility or freestanding surgery center has been met for this calendar year.
[CUSTOMER][NEGATIVE] OK, hold on just a second, I don't think we've received.
[AGENT][NEUTRAL] I know that was a
[CUSTOMER][NEUTRAL] Oh yeah we did. I just didn't dig deep enough. I'd had to call anyway, OK, so the max for the cal uh accident surgical outpatient has been met for the year.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, may I have a call reference number please?
[AGENT][NEUTRAL] Oh, you betcha. It's my name, [PII], first initial, last name, [PII], and then today's date.
[CUSTOMER][POSITIVE] I appreciate it [PII] hope you have a wonderful day.
[AGENT][POSITIVE] Hey, my pleasure. Thanks for calling, Miss [PII]. You have a great day too.
[CUSTOMER][POSITIVE] Thank you, ma'am bye bye.
[AGENT][NEUTRAL] Bye bye.