AccountId: 011433970860
ContactId: 01fcb306-dc25-49a4-a94b-c2521373d51b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 410140 ms
Total Talk Time (AGENT): 130620 ms
Total Talk Time (CUSTOMER): 147797 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/01fcb306-dc25-49a4-a94b-c2521373d51b_20250402T17:57_UTC.wav
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[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I have a claim that tonight and I'm hoping that you can give me some additional information on it, please.
[AGENT][NEUTRAL] Yes, Ms. [PII], I can give you additional information. Can you please give me your callback number just in case the call gets disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, and then is the claim for yourself or is it for a patient?
[CUSTOMER][NEUTRAL] It's for a patient. I'm calling from calling from a provider's office.
[AGENT][NEUTRAL] OK, and what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] [PII], date of birth [PII], and the policy number is 02345443.
[AGENT][NEUTRAL] OK, let me pull that up real quick.
[AGENT][NEUTRAL] OK and then can you please give me the date of service and the charge amount?
[CUSTOMER][NEUTRAL] OK, it's kind of old. [PII] and I have.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] $2,674.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then um OK, what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Um, Union Hospital.
[AGENT][NEUTRAL] Union Hospital.
[CUSTOMER][NEUTRAL] Yeah, I have Union Hospital Association.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK dokey. I'm gonna put you on a brief hold while I pull up this claim and I will be right back, [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, Miss [PII], I have the claim pulled up. The claim number is 3407822.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And um.
[AGENT][NEUTRAL] So the maximum ER visit for outpatient for accident or sickness treatment was maxed for the emergency room.
[CUSTOMER][NEUTRAL] S
[CUSTOMER][NEUTRAL] 6 months. OK, hold on, I'm writing this down, sorry.
[AGENT][NEUTRAL] So the claim was denied.
[CUSTOMER][NEUTRAL] Maximum ER visit for accident or sickness for treatment.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then wait ER is it OK.
[CUSTOMER][NEUTRAL] So, like I said, it's, it's older. So what, what is your appeal time frame? Do we, what, what just for I just for me to know, what is your appeal time frame?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It has to be done within 180 days from the date the claim was initially processed and then a letter will also need to be sent with the appeal.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Well, of course, we're past it. I'm just, I'm just writing that down from my notes because I'm not, I'm not familiar with your, I'm not, yeah, I'm not familiar with your insurance company. So, your insurance company is 180 days.
[AGENT][NEUTRAL] Yes, ma'am, I understand.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, and then you gave me the um the claim number, so thank you. Can you give me the date of the now for this claim because I, I don't have that, sorry.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yes, yes, ma'am. Let me look that up real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim was received on [PII].
[AGENT][NEUTRAL] And then it was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Oh, I don't know why am I getting this now, OK.
[CUSTOMER][NEUTRAL] OK, so there's nothing we could do. Yeah, I just want like, I just, I don't know why I have this now, but let me call. OK, so nothing we could do about this one. OK. Can I get a um a reference number for our call, please?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Yes ma'am you can use my.
[AGENT][NEUTRAL] Well
[CUSTOMER][NEUTRAL] I, I'm sorry, the call is breaking up. You said your name?
[AGENT][NEUTRAL] Yes, it's [PII] and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] and then today's date. OK, thank you.
[AGENT][POSITIVE] Yes, ma'am. You're so very welcome. Is there anything else, Miss [PII], I can help you with before we go?
[CUSTOMER][NEUTRAL] Um, well, just for my notes, like I said, um, if I was to get anything else for you guys, do you have a fax number if I was to fax them to you?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, the, um, let me give you the fax number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] 877.
[CUSTOMER][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] 942-3877365-9423
[CUSTOMER][POSITIVE] OK, OK, thank you. I appreciate it.
[AGENT][POSITIVE] OK. You're welcome, Miss [PII]. You have a blessed day and thanks for calling APL.
[CUSTOMER][POSITIVE] You too. I appreciate it. Have a good day.
[AGENT][NEUTRAL] Bye-bye.