AccountId: 011433970860
ContactId: e4cda0fa-43a4-449c-b317-80b8878b84ea
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 201039 ms
Total Talk Time (AGENT): 53927 ms
Total Talk Time (CUSTOMER): 76150 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/e4cda0fa-43a4-449c-b317-80b8878b84ea_20250611T20:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I was calling to um get a claim status.
[AGENT][NEUTRAL] I can help you with claim status, [PII]. Can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Update
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Policy is 02280020.
[AGENT][NEUTRAL] OK, give me just one moment to look that up.
[AGENT][NEUTRAL] And can I get the patient's uh name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] I'm sorry, [PII].
[AGENT][POSITIVE] Thank you so much for verifying. Give me just one moment.
[AGENT][NEUTRAL] Do you have the claim number or the date of service?
[CUSTOMER][NEUTRAL] Um, data services [PII]. I think I got inside you guys portal, but it's the EOB is kind of vague. I have a claim number of 3,604,910.
[AGENT][NEUTRAL] OK, let me pull that up. And what is the provider or the hospital name?
[CUSTOMER][NEUTRAL] Bay Area Houston endoscopy Center.
[AGENT][NEUTRAL] OK, give me just one moment.
[AGENT][NEGATIVE] Yeah, it looks like it was denied because they had met their calendar year maximum.
[CUSTOMER][NEUTRAL] So we're um making that the patient's responsibility?
[AGENT][NEUTRAL] We don't determine patient responsibility that's up to the provider.
[CUSTOMER][NEUTRAL] Oh, OK, but, um, so we denied for max benefits meant for the calendar year?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, every calendar year. I guess that was correct. And just to confirm, um,
[CUSTOMER][NEUTRAL] It finalized on.
[CUSTOMER][NEUTRAL] It doesn't say it doesn't tell me when it finalized. When did it finalize?
[AGENT][NEUTRAL] OK, let me look.
[AGENT][NEUTRAL] It looks like we uh finished processing it on [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] May I please get a call reference number?
[AGENT][NEUTRAL] So we don't have call reference numbers, but you can use my name and last initial in today's date. So it'd be [PII] in today's date.
[CUSTOMER][POSITIVE] OK, I will use that. Thank you so much, [PII].
[AGENT][POSITIVE] Great, thank you for calling APL [PII]. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye.