AccountId: 011433970860
ContactId: e4b60395-a8a5-43d9-83be-61a9731c1b5b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 478489 ms
Total Talk Time (AGENT): 133767 ms
Total Talk Time (CUSTOMER): 192842 ms
Interruptions: 8
Overall Sentiment: AGENT=0.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/e4b60395-a8a5-43d9-83be-61a9731c1b5b_20250613T20:57_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling on behalf of Saint Vincent Booming to check out the current status.
[AGENT][NEUTRAL] I'm sorry, it's a little bit difficult to hear you. Did you say we're checking on a claim?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, uh, I can check on a claim for you. Uh, can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. The policy number is 02478036.
[AGENT][NEUTRAL] OK, and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. What was the date of service for this claim?
[CUSTOMER][NEUTRAL] Yeah, sure. It's
[CUSTOMER][NEUTRAL] [PII] and the total charges is
[CUSTOMER][NEUTRAL] $10,480 even.
[AGENT][NEUTRAL] OK, that was [PII]?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and that was for $10,480?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK thank you one moment please.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so we did receive this claim we were unable to pay a benefit as the calendar year maximum for this or excuse me, the benefit maximum for the state of service has been met.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If you'd like I can send you a copy of this EOB.
[CUSTOMER][NEUTRAL] May I know the benefits exhausted.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, do you have a fax number?
[CUSTOMER][NEUTRAL] Yes, we have a fax number.
[AGENT][POSITIVE] OK, I'm ready when you are.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Can I give it to you?
[AGENT][POSITIVE] Yes, I'm ready for it.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, the fax number is [PII].
[AGENT][NEUTRAL] OK, I'm gonna read that back to make sure I heard that correctly. That was [PII].
[CUSTOMER][NEUTRAL] So I don't
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I can go ahead and get that sent to you now. Should get it within about 10 minutes or so. Um, did you need that claim number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, that is 34.
[AGENT][NEUTRAL] 59.
[AGENT][NEUTRAL] 424.
[CUSTOMER][NEUTRAL] Mm, may I know the received date and date for this time.
[AGENT][NEUTRAL] This claim was received [PII], and it was processed on [PII].
[CUSTOMER][NEUTRAL] Twice.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm, uh, the claim was denied, right?
[AGENT][NEUTRAL] Correct, as the benefit maximum had been met for the data service.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. May I know the
[CUSTOMER][NEUTRAL] Maximum benefits is applied to the patients visits or uh applied to the amount.
[AGENT][NEUTRAL] Yes, so this policy pays $50 for an office visit.
[CUSTOMER][NEUTRAL] so you would.
[AGENT][NEUTRAL] And this one was, uh, I believe it was for an emergency room.
[CUSTOMER][NEUTRAL] Sorry, sorry.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Um, may I know the.
[CUSTOMER][NEUTRAL] Dollars.
[AGENT][NEUTRAL] Yes, it's $50 per calendar day.
[CUSTOMER][NEUTRAL] 50 visits per calendar year, right?
[AGENT][NEUTRAL] No, $50 per calendar day.
[CUSTOMER][NEUTRAL] 2
[CUSTOMER][NEUTRAL] Do
[CUSTOMER][POSITIVE] OK, thanks for that and uh.
[CUSTOMER][NEUTRAL] And uh may I know the.
[CUSTOMER][NEUTRAL] How many dollars paid for the patients?
[CUSTOMER][NEUTRAL] Is it?
[AGENT][NEUTRAL] So this for this date of service we paid a benefit of $50 to a claim that was filed before this one for the same date of service.
[CUSTOMER][NEUTRAL] OK 35.
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, yeah, I do have this is.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] I don't.
[CUSTOMER][NEUTRAL] right.
[CUSTOMER][NEUTRAL] Hello, are you there?
[AGENT][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] Um, is that a patient exceeded the dollars or not?
[AGENT][NEUTRAL] We paid the maximum benefit to a claim prior to this one for the same date of service so no benefits were payable for this claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How long is it gonna take
[CUSTOMER][POSITIVE] OK, thanks, thanks for that.
[CUSTOMER][NEUTRAL] It's.
[AGENT][NEUTRAL] Was there anything else I can help you with?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You know.
[AGENT][NEUTRAL] There wasn't anything else I can help you with?
[CUSTOMER][NEUTRAL] No, thanks for that. Uh, may I know the call reference number for this?
[AGENT][NEUTRAL] Sure, reference number would just be my first name, last initial, and today's date.
[CUSTOMER][NEGATIVE] No, no.
[AGENT][NEUTRAL] So my name is spelled [PII]
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, thanks, [PII]. Thanks for your valuable time and information. Have a good day.
[AGENT][POSITIVE] Of course, thanks for giving us a call. Have a great rest of your day. Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I try to.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.