AccountId: 011433970860
ContactId: e94caf38-c842-4936-8f53-7cb54d4cf7a9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 308609 ms
Total Talk Time (AGENT): 115196 ms
Total Talk Time (CUSTOMER): 153182 ms
Interruptions: 5
Overall Sentiment: AGENT=0.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/e94caf38-c842-4936-8f53-7cb54d4cf7a9_20250211T22:00_UTC.wav
--------------------------------------------
[CUSTOMER][NEUTRAL] Uh
[AGENT][POSITIVE] Thank you for calling APL this is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] calling from Pro's office.
[AGENT][NEUTRAL] Hi [PII], how are you?
[CUSTOMER][POSITIVE] I'm fine. How are you? Thanks for asking that.
[AGENT][POSITIVE] I'm doing well, thank you. What can we do for you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, good. Well, can I get the claim status, please?
[AGENT][NEUTRAL] Sure, 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] you
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII]. Is the direct line.
[AGENT][NEUTRAL] Alright, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Alright thank you. And then do you have
[CUSTOMER][NEUTRAL] Yeah, I'm so sorry. I can't provide the policy number. I can provide the member ID or the tax ID NPI.
[AGENT][NEUTRAL] Um, the policy number or the member ID would work.
[CUSTOMER][POSITIVE] Oh, OK, well, I'm so sorry about that and the member ID is.
[CUSTOMER][NEUTRAL] 02492690.
[AGENT][NEUTRAL] OK, thank you, and then what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] What was the name and date of
[CUSTOMER][NEUTRAL] And the first name is [PII] and the middle name is [PII], and the last name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that day. What was the date of service for this claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm that was [PII]?
[CUSTOMER][NEUTRAL] I was
[CUSTOMER][POSITIVE] Yes, you're right.
[AGENT][NEUTRAL] OK, OK, and what was the bill amount, please?
[CUSTOMER][NEUTRAL] $2,492 even.
[AGENT][POSITIVE] OK, thank you one moment please.
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] I'm sorry, [PII], what was the name of the uh provider's office?
[CUSTOMER][NEUTRAL] Yeah, it's uh.
[CUSTOMER][NEGATIVE] Saint Joseph like mad.
[AGENT][NEUTRAL] OK, thank you for verifying that. Alrighty, so we did receive this claim, uh, we were unable to pay a benefit as the calendar year maximum uh for this benefit had been met.
[CUSTOMER][POSITIVE] OK, thank you for verifying that.
[CUSTOMER][NEUTRAL] Maybe.
[CUSTOMER][NEUTRAL] To a.
[CUSTOMER][NEUTRAL] OK, well, can I get the receipt date, please?
[AGENT][NEUTRAL] Of course, just a moment let me get that for you.
[AGENT][NEUTRAL] OK, so we've received that [PII].
[CUSTOMER][NEUTRAL] So we've received that [PII].
[AGENT][NEUTRAL] And it was processed [PII], so just today.
[CUSTOMER][NEUTRAL] And it was
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Well, can I get the claim number, please?
[AGENT][NEUTRAL] Yes, that is 356-2054.
[CUSTOMER][NEUTRAL] Yes, that is 35. OK, well, may I know the please.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Denial reason.
[AGENT][NEUTRAL] Uh, so their maximum benefit had already been met.
[CUSTOMER][NEUTRAL] Uh, so their maximum benefit had already been met.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] If you'd like, [PII], I can send you a copy of this EOB.
[CUSTOMER][NEUTRAL] If you'd like to, I can send you a copy of the COB.
[CUSTOMER][NEUTRAL] Yeah, well, when will we get the EOB and may I know that.
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] Well, when it will get to me, you will be.
[AGENT][NEUTRAL] I can fax it to you if you'd like.
[CUSTOMER][NEUTRAL] To
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, what was that fax number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] The fax number is, give me one moment, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, the fax number is, are you ready for this?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] What was the last digit? I'm sorry?
[CUSTOMER][NEUTRAL] Yeah, it's OK I'm repeating again. It's [PII].
[AGENT][NEUTRAL] OK, OK, got it. I'm gonna read it back to you, [PII], just to make sure I heard that correctly. That was [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 2
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes, you are right.
[AGENT][NEUTRAL] OK, and I would just put this to your attention.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, alrighty, I will get that sent to you. You should get it here in maybe 10-15 minutes depending on how busy your machine is. Was there anything else I could help you with?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Your machine is was there anything else?
[CUSTOMER][NEUTRAL] Yeah, well, uh, can I get the claim num I mean call reference number please.
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII]
[CUSTOMER][NEUTRAL] see my first name, last initial [PII] is spelled [PII]
[CUSTOMER][POSITIVE] OK, thank you very much for your information.
[AGENT][POSITIVE] Of course, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][POSITIVE] Thank you, bye bye.