AccountId: 011433970860
ContactId: 000b97f9-a138-4e4e-a608-40a5cbf0a9fa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 436440 ms
Total Talk Time (AGENT): 105861 ms
Total Talk Time (CUSTOMER): 62979 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=-0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/000b97f9-a138-4e4e-a608-40a5cbf0a9fa_20250404T15:53_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good morning. So this is [PII] and I'm calling from West Kendall Baptist Hospital regarding a claim.
[AGENT][NEUTRAL] OK, sure. I can assist you with claims, Ms. [PII]. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Of course, [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 02325489 M like Mary L like Larry 8.
[AGENT][NEUTRAL] Thank you. And what's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Alright perfect thank you and what is the date of service and the amount of claims?
[CUSTOMER][NEUTRAL] [PII] total charges $4400 even.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] Let me see if I have that claim and I just need to let you know that for future you can check claim status online through our website at [PII] and that's just optional. And let's see, looks like we processed twice. Um, the last one was processed as a duplicate, so I'm gonna give you the information of the original one, OK? Um, let me pull this information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so the original claim was processed on [PII] and the claim was denied. The reason for this denial is that outpatient benefits for the calendar year has been met.
[CUSTOMER][NEUTRAL] OK, so the max has been exceeded for the year.
[AGENT][POSITIVE] Correct, mhm.
[CUSTOMER][POSITIVE] Perfect. So can you, um, would you be able to provide me an EOB?
[AGENT][NEUTRAL] Uh, a fax? Is that OK?
[CUSTOMER][NEUTRAL] Yes, yes, that's fine.
[AGENT][NEUTRAL] Yes. All right. Yes, that is the fax number?
[CUSTOMER][NEUTRAL] Um [PII].
[CUSTOMER][NEUTRAL] 533. Give me one second. Let me make sure I'm giving that to you guys. Yeah, so [PII].
[AGENT][NEUTRAL] OK, [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK. And do you mind holding for me while I send this out to you while I got you on the line right now?
[CUSTOMER][NEUTRAL] Of course, of course, go ahead.
[AGENT][NEUTRAL] All right, thank you. One moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me, Ms. [PII]. OK, I'll send that over to you. It should be there in a few minutes. If you don't get it within 15 minutes, you can give us a call back and we can resend it, but it should be there by then. Is there anything else I'm gonna help you with today?
[CUSTOMER][POSITIVE] Um, no, that was it. Thank you so much for your help. Is there a reference number for our call?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date.
[CUSTOMER][POSITIVE] OK, sounds good. Thank you so much again.
[AGENT][POSITIVE] You're welcome. Thank you for calling APR. Have a good weekend.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you.