AccountId: 011433970860
ContactId: 0db027c3-4ac8-4aa8-a0ce-92b86ecdf42f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 369760 ms
Total Talk Time (AGENT): 132934 ms
Total Talk Time (CUSTOMER): 91267 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/0db027c3-4ac8-4aa8-a0ce-92b86ecdf42f_20250409T13:28_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL to see how can I help you?
[CUSTOMER][NEUTRAL] Hi. Uh, this is [PII] from Coastal Carolina Medical Center and I would like to check the claims.
[AGENT][NEUTRAL] OK, [PII], you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, I can help you with that, [PII]. What is your callback number?
[CUSTOMER][NEUTRAL] Sure. My callback number is [PII]. No extension, that's a direct line.
[AGENT][NEUTRAL] OK, thank you. And [PII], how many claims do you have to check status on?
[CUSTOMER][NEUTRAL] Uh, just one name only.
[AGENT][NEUTRAL] OK. Yes, ma'am. I can help you with that. And what is the patient's policy number?
[CUSTOMER][NEUTRAL] Uh, the member ID is 02365128.
[AGENT][NEUTRAL] OK, [PII], thank you. Give me a couple of moments please to get the member's information pulled up.
[CUSTOMER][NEUTRAL] Sure, yeah.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, ma'am, any information that I do provide for you would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, first name is uh [PII], last name is [PII]. The date of birth of [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Sure. The date of service is [PII] with a total amount of $5,369 even.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you did say [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sorry. Say the date one more time? I heard you correctly.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And again, the bill amount?
[CUSTOMER][NEUTRAL] It's $5,369 even.
[AGENT][NEUTRAL] 5369, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so this claim was received. It was for 1-2025.
[AGENT][NEGATIVE] It was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is
[AGENT][NEUTRAL] 358.
[AGENT][NEUTRAL] 4461.
[AGENT][NEUTRAL] And the reason for the denial states outpatient.
[CUSTOMER][NEUTRAL] Sorry to cut you.
[CUSTOMER][NEUTRAL] Uh, can you repeat the claim number cause your, uh, your line is cutting in and out. I'm sorry.
[AGENT][NEUTRAL] 358.
[AGENT][NEUTRAL] 461.
[AGENT][NEUTRAL] And the reason for the denial states outpatient benefit.
[AGENT][NEUTRAL] For this calendar year.
[AGENT][NEUTRAL] Has been met.
[CUSTOMER][POSITIVE] All right. I got it. Thank you so much. I appreciate your help.
[AGENT][POSITIVE] You're welcome. And yes, [PII], you're welcome.
[CUSTOMER][NEUTRAL] Um, I think that would be all.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and if you need a copy of this explanation of this, you may print that directly from our portal. Now that you have the claim number by going to [PII].
[AGENT][POSITIVE] And is there anything else I can help you with, [PII]? Oh, certainly. Yes, ma'am.
[CUSTOMER][POSITIVE] All right, got it. I appreciate your help again.
[CUSTOMER][NEUTRAL] Uh, just the reference number.
[AGENT][NEUTRAL] OK. It would be my name, well again, which is [PII] and the first initial to my last name is [PII].
[AGENT][NEUTRAL] So it's my name and today's date.
[CUSTOMER][POSITIVE] OK, I appreciate your help, [PII]. Have a great day, please stay safe.
[AGENT][POSITIVE] OK. Well, I hope you do too, [PII], and again, thank you for calling APL.
[CUSTOMER][POSITIVE] Mhm good bye.
[AGENT][NEUTRAL] Bye bye.