AccountId: 011433970860
ContactId: d2e682be-beb0-4b87-a60a-bb6a01813386
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 308980 ms
Total Talk Time (AGENT): 91716 ms
Total Talk Time (CUSTOMER): 157881 ms
Interruptions: 6
Overall Sentiment: AGENT=1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/d2e682be-beb0-4b87-a60a-bb6a01813386_20250404T19:06_UTC.wav
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[CUSTOMER][NEUTRAL] Hi [PII]. This is [PII] calling from provider's office. How are you doing today?
[AGENT][NEUTRAL] For calling APL, this is [PII]. How can I help you?
[AGENT][POSITIVE] I'm doing well, [PII], how are you?
[CUSTOMER][POSITIVE] I'm doing great thank you for checking on me [PII] and yeah so I'm here to check on claim status you could assist me with that.
[AGENT][NEUTRAL] Sure, I can check on a claim for you. Uh, and I, can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, that will be [PII] with an [PII].
[AGENT][NEUTRAL] OK, thank you. And do you have that policy number?
[CUSTOMER][NEUTRAL] Oh yeah, let me provide you that just a moment. Uh, before that, can I get your last name initials, [PII]?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, last initial is [PII]
[CUSTOMER][POSITIVE] Got it, thank you, [PII]. And yeah, just a moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, that'll be 945137.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That is [PII] with the date of birth, [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. What was the date of service for this claim?
[CUSTOMER][NEUTRAL] That's on [PII] with the total bill amount of.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] $742.50. 742.50.
[AGENT][POSITIVE] Got it. OK, thank you. One moment please.
[CUSTOMER][POSITIVE] No, I'm too good. I didn't have a.
[CUSTOMER][POSITIVE] Oh sure, take your time.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Maybe not the.
[CUSTOMER][NEUTRAL] No, not
[AGENT][NEUTRAL] And what was the name of the provider's office this was with?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, yeah, sure. Let me provide you those details, just a moment.
[CUSTOMER][NEUTRAL] That will be for Duke University affiliated also goes by Duke Primary Cain.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Alrighty, so for this claim, uh, we were unable to pay a benefit as the calendar year maximum of, they only get a maximum of 4 doctor visits uh per person per calendar year and those had been met.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] said that.
[CUSTOMER][NEUTRAL] Who
[CUSTOMER][NEUTRAL] Studio
[CUSTOMER][NEUTRAL] May I know when was the last uh time it was built?
[CUSTOMER][NEUTRAL] Or the claim number in which it was billed back.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Yes, so this claim number is 3508874.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 74. OK. And in this claim it was billed last, right? And it was paid last.
[AGENT][NEGATIVE] This claim was not paid, no. We received this claim after they had already met their maximum.
[CUSTOMER][NEUTRAL] Uh, do you have a claim number in which they have met the uh maximum or the date?
[AGENT][NEUTRAL] I'm not able to give that as that is from a different provider.
[CUSTOMER][NEUTRAL] Oh, got it.
[CUSTOMER][POSITIVE] Got it, thank you. And uh.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh, uh, what is the family filing for submitting a corrected claim with you guys?
[AGENT][NEUTRAL] Um, there's not one for corrected claims. However, if it were an appeal that is, uh, has to be within 180 days of the process date in which this process date was [PII].
[CUSTOMER][NEUTRAL] That.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] Got it. Thank you.
[CUSTOMER][NEUTRAL] Can I get a call reference number for this please?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, your name is spelled as [PII]?
[AGENT][NEUTRAL] Uh, it's [PII]
[CUSTOMER][POSITIVE] OK, alright, got it. Thank you. Thank you so much, [PII]. I've got all the required information and have a great day ahead.
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] You too. Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] that.