AccountId: 011433970860
ContactId: 0ff8c4d1-1550-4114-87ee-6bb59926c897
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 309940 ms
Total Talk Time (AGENT): 121269 ms
Total Talk Time (CUSTOMER): 92938 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/0ff8c4d1-1550-4114-87ee-6bb59926c897_20250227T15:03_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling from Saint Mary's Hospital regarding claim status. Could you please help me with it?
[AGENT][NEUTRAL] OK, I'm so sorry, but I'm having trouble understanding you.
[CUSTOMER][NEUTRAL] Uh, hi, [PII]. My name is [PII] calling from Saint Mary's Hospital regarding claims. How you with this.
[AGENT][NEUTRAL] OK, [PII], did you say your name is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and [PII], you're needing claim status, is that correct?
[CUSTOMER][POSITIVE] Yes, yes, yes, [PII].
[AGENT][NEUTRAL] Yes, I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and [PII], how many claims do you have today?
[CUSTOMER][NEUTRAL] Just one, please.
[AGENT][NEUTRAL] OK, and what is that member's policy number?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] It's 01734133 M as in Mike, L as in Lima, 8.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Just to see.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name, please, and their date of birth?
[CUSTOMER][NEUTRAL] Sure, the patient's first name, [PII], and the last name, [PII].
[CUSTOMER][NEUTRAL] And the date of birth, uh, [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Can you, could you please spell out your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] You're welcome. And what is the date of service and total bill amount for him, please?
[CUSTOMER][NEUTRAL] Uh, it's uh [PII] and the bill amount $124 even.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so this claim was received. The received date, [PII] was 115-2024.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was processed and denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 352-777-6.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the reason for the denial on this claim states outpatient benefit for this calendar year has been met.
[CUSTOMER][POSITIVE] Oh thank you, thank you so much uh.
[AGENT][NEUTRAL] You're welcome. And if you need a copy of this explanation of benefits, you may go to our portal and print that and our portal website is [PII].
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] Thank you so much one moment um.
[CUSTOMER][NEUTRAL] Uh, could you please uh fax this UB to our fax number?
[AGENT][NEUTRAL] Are you not able to print?
[CUSTOMER][NEUTRAL] Yes, yes, [PII]. Um,
[AGENT][NEUTRAL] Again, you can print the explanation of benefits from our portal.
[AGENT][NEUTRAL] At the website that I gave you for the portal.
[CUSTOMER][NEUTRAL] Oh yes, [PII]. [PII], could you please help me with uh the portal luggage?
[AGENT][POSITIVE] It is secured.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] AM [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Um, and, uh, uh, [PII], could you please help me with the call reference number?
[AGENT][NEUTRAL] Yes, the call reference number [PII] would be my name along with today's date.
[CUSTOMER][POSITIVE] Yeah, that's great. Thank you. Thank you so much, [PII]. Well have a great day. Stay safe. Bye for now.
[AGENT][POSITIVE] Yeah. Yes, ma'am. I hope you have a great day as well and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Uh-huh, bye bye.