AccountId: 011433970860
ContactId: fcf62a2e-f3f2-45f0-aea4-476552610769
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 190690 ms
Total Talk Time (AGENT): 80665 ms
Total Talk Time (CUSTOMER): 64228 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/fcf62a2e-f3f2-45f0-aea4-476552610769_20250509T17:11_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, yes. My name is [PII]. I'm calling from uh claims.
[AGENT][NEUTRAL] OK, I can check on a claim for you. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Yes, it is 024.
[CUSTOMER][NEUTRAL] 73249 M for Mary, L for Larry, 8.
[AGENT][NEUTRAL] OK, and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that and what was the date of service for this claim?
[CUSTOMER][NEUTRAL] This is for [PII].
[AGENT][NEUTRAL] OK, do you have that filled out?
[CUSTOMER][NEUTRAL] $21,855.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so we did receive this claim, [PII], uh, we were unable to pay a benefit as their maximum benefit payable for this state of service had been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK. So Medicare paid the max allow, um, not Medicare, um,
[AGENT][NEUTRAL] Their primary?
[CUSTOMER][NEUTRAL] Blue Cross paid the max allowable?
[AGENT][NEUTRAL] Um, no, so this is just for this patient's policy. So the way that this policy operates, give me just a moment, their outpatient benefit pays on a per calendar day basis, so this one pays $300 max per calendar day, and that had been matched uh with a prior claim for the same date of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, I see.
[CUSTOMER][NEUTRAL] OK, so whoever uh built the service before us received a payment, and that's it.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Got you OK.
[CUSTOMER][NEUTRAL] OK. May I have a call reference number?
[AGENT][NEUTRAL] Sure, reference number would just be my first name. I'm sorry?
[CUSTOMER][NEUTRAL] Now
[CUSTOMER][NEUTRAL] OK, one more thing, would this be patient responsibility then?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Uh, we do not say what is patient responsibility that would be up to the provider.
[CUSTOMER][POSITIVE] Got you OK.
[CUSTOMER][NEUTRAL] All right. Uh, may I have a call reference your name you said?
[AGENT][NEUTRAL] Uh yes, my first name, last initial, and today's date and so my name is spelled [PII] Was there anything else I could help you with?
[CUSTOMER][POSITIVE] That's all, thank you.
[AGENT][POSITIVE] Alright, yeah, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] You too. Thanks. Bye-bye.
[AGENT][POSITIVE] Of course thank you bye bye.