AccountId: 011433970860
ContactId: e7786525-0b9a-4fff-b9f5-575749562878
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 549070 ms
Total Talk Time (AGENT): 108902 ms
Total Talk Time (CUSTOMER): 188892 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/e7786525-0b9a-4fff-b9f5-575749562878_20250415T19:39_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]. How are you?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][POSITIVE] I'm also good.
[CUSTOMER][NEUTRAL] Uh, [PII], I am looking for a general claim status. My name is [PII] calling from Osar Medical Center.
[AGENT][NEUTRAL] OK, I can help you with claim status, [PII]. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Uh [PII]. But before proceeding, can you spell out your name?
[AGENT][NEUTRAL] Yes, it's [PII]. It's [PII]
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] And what was the callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the policy number of the patient?
[CUSTOMER][NEUTRAL] 02335719
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII], and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you. And the date of service and build them out?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The date of service is [PII], bill amount $760.
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] [PII], not [PII] built amount $760 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Uh, looks like that claim was received 5-13-2024, processed on the same day.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Calendar year maximum was met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How much dollar amount has been met and
[CUSTOMER][NEUTRAL] How much dollar amount is allowed?
[AGENT][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] I'm checking. Hold on one moment.
[CUSTOMER][POSITIVE] Yeah, you can take your time.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Uh, they get 30 visits for a calendar year.
[CUSTOMER][NEUTRAL] 30 digits or $30?
[AGENT][NEUTRAL] Um, it is dirty visits. Let me double check.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] the
[AGENT][NEUTRAL] Uh it's $30 per day.
[AGENT][NEUTRAL] A maximum of one day per calendar year.
[CUSTOMER][NEUTRAL] $30.
[CUSTOMER][NEUTRAL] OK. And just do it.
[CUSTOMER][NEUTRAL] And how many visits in a year?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, one per year.
[CUSTOMER][NEUTRAL] Only one visit per year or per day?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Per year.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Only 1 visit per year and you paid only $30 for one visit, right?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And what's the plan name?
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] My name is [PII] UTBA.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Mm, can you repeat?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][POSITIVE] [PII], [PII] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, [PII]. Just wait a second. But as I can see, we do not, do not receive any payment on this account.
[CUSTOMER][NEUTRAL] Uh, that means the patient has already met before this account, right?
[AGENT][NEUTRAL] Yes, they've met their max prior to this state of service.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I have one more claim for the same patient.
[AGENT][NEUTRAL] And the date of service?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Native service.
[CUSTOMER][NEUTRAL] Yeah, but before data service, can you provide me the claim number?
[AGENT][NEUTRAL] 345.
[CUSTOMER][NEUTRAL] It's 3,454,960, right? OK. My next date of service is [PII].
[AGENT][NEUTRAL] 4960.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII], same patient?
[CUSTOMER][NEUTRAL] Yeah, same.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, looks like that claim was received [PII], processed the same day.
[AGENT][NEUTRAL] We made a payment of $30.
[CUSTOMER][NEUTRAL] What about the remaining balance? Do you have any idea about that?
[AGENT][NEUTRAL] I can just tell you what we paid on the claim. We paid $30.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] And remaining each patient responsibility?
[AGENT][NEUTRAL] We don't determine patient responsibility.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Just wait a second.
[AGENT][NEUTRAL] Hello, are you there?
[CUSTOMER][NEUTRAL] Yeah, yeah, I'm on the line. I'm just checking.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, just provide me the call reference number, please. You'll be.
[AGENT][NEUTRAL] A call reference number is my name, [PII], first initial to last name, [PII], and today's date.
[CUSTOMER][POSITIVE] OK, thank you, [PII]. Have a nice day.
[AGENT][POSITIVE] Thanks for calling APLU as well.
[CUSTOMER][NEUTRAL] I