AccountId: 011433970860
ContactId: 17dd9315-0b2d-420a-a364-d77376827e6a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 469109 ms
Total Talk Time (AGENT): 145704 ms
Total Talk Time (CUSTOMER): 113114 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/17dd9315-0b2d-420a-a364-d77376827e6a_20250219T21:09_UTC.wav
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[AGENT][POSITIVE] Good afternoon, thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, um, this is [PII]. I'm calling from the business office of BHS Brownsville Hospital, and I'm checking for a claim status, and I just want to inform you that this call is being monitored and recorded for quality and training purposes.
[AGENT][NEUTRAL] OK, I can verify claim status for you and I apologize your name is again?
[CUSTOMER][NEUTRAL] My name is [PII], spelled [PII] By the way, uh this is for appeal status rather.
[AGENT][NEUTRAL] OK, uh, what's that policy number, please?
[CUSTOMER][NEUTRAL] 01868768. What is your name again?
[AGENT][NEUTRAL] It's [PII], last initial [PII].
[AGENT][NEUTRAL] And give me a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, thank you. And you say you're calling about uh pill status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, do you have a data service and amount of the charge for the claim?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] For the bill amount of.
[CUSTOMER][NEUTRAL] $15,710 even.
[AGENT][NEUTRAL] OK, thank you. And I forgot [PII], do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, [PII], no extension.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] Uh, give me one moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me see.
[AGENT][NEUTRAL] OK, I show a response has been sent. Uh, it was sent [PII].
[AGENT][NEUTRAL] As
[AGENT][NEUTRAL] Uh regarding your claim made under a medical plan, we have reconsidered your claim and determined that it was processed correctly in accord with the policy contracts in it.
[AGENT][NEUTRAL] Explain the type of policy the insured has and the benefits.
[AGENT][NEUTRAL] And it looks like we received a second appeal and information was sent on [PII].
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yeah, so.
[CUSTOMER][NEUTRAL] As for [PII] for appeal is still upheld, correct.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, how about the appeal?
[CUSTOMER][NEUTRAL] Uh, that was submitted on [PII].
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Uh, this was for another data service, or was it the same? Give me a second.
[CUSTOMER][NEUTRAL] No, the same date of service.
[AGENT][NEUTRAL] And it was the same. It's been determined that it was processed correctly and in accordance with the policy contract.
[AGENT][NEUTRAL] And that was processed on [PII].
[CUSTOMER][NEUTRAL] Is this available this.
[CUSTOMER][NEUTRAL] [PII], 1 moment.
[CUSTOMER][NEUTRAL] When did you receive the claim, uh, the appeal, sorry.
[AGENT][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] What is the document number for this one or case number?
[AGENT][NEUTRAL] Uh, there's a claim number attached. It's 3556756.
[CUSTOMER][NEUTRAL] So 355-675-6 correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Um, can you confirm if this claim is available?
[AGENT][POSITIVE] It's already been appealed 3 times and it's been processed as it was processed correctly according to the policy contract.
[CUSTOMER][NEUTRAL] But um appeal is possible for this claim, correct?
[AGENT][NEUTRAL] You have up to 2 appeals. You've done 3.
[CUSTOMER][NEUTRAL] So I feel possible. however, it got denied you to claim correctly process.
[AGENT][NEUTRAL] You've maxed the number of appeals because uh it was processed as uh determined that the claim was correctly processed according with the policy contract.
[CUSTOMER][NEGATIVE] So I feel already exhausted for this one,
[AGENT][NEUTRAL] Yes, you have up to 2 appeals.
[AGENT][NEUTRAL] We've already did 3.
[CUSTOMER][NEUTRAL] Can you send a copy of [PII]?
[AGENT][NEUTRAL] Or a copy of the appeal letter?
[CUSTOMER][NEUTRAL] Um, copy of a letter to fax.
[AGENT][NEUTRAL] Sure. What's the fax number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Fax number.
[CUSTOMER][NEUTRAL] Let me check one moment.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, that's [PII].
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK. Is there anything [PII] I can assist you with today?
[CUSTOMER][NEUTRAL] Um, how long will it take to receive the letter?
[AGENT][NEUTRAL] Or you get it before the end of the day.
[CUSTOMER][NEUTRAL] OK, I'll just change for us for this. Um, what's the call reference number before we end this call, [PII]?
[AGENT][NEUTRAL] Uh, we don't give reference numbers. If you like, you may use my name on today's date.
[CUSTOMER][POSITIVE] OK, by the way, thank you so much for your assistance bye for now.
[AGENT][POSITIVE] You're welcome. Thank you for calling APL. Bye.
[CUSTOMER][NEUTRAL] Bye.