AccountId: 011433970860
ContactId: 19035cdf-cfd3-4e2c-ab88-0708e536c600
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 635700 ms
Total Talk Time (AGENT): 120510 ms
Total Talk Time (CUSTOMER): 101403 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/19035cdf-cfd3-4e2c-ab88-0708e536c600_20250307T20:40_UTC.wav
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[AGENT][POSITIVE] Thank you for calling and APL this is [PII] how may I help you?
[CUSTOMER][NEUTRAL] Uh, hi, my name is [PII]. I'm calling from Piedmont Atlanta Hospital to check on the status of the claim. Could you please spell your name?
[AGENT][NEUTRAL] Uh, yes, it's [PII]
[CUSTOMER][NEUTRAL] Your initial, please?
[AGENT][NEUTRAL] A
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] OK, [PII], and you said you were calling from Piedmont?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, how can I help you today, [PII]?
[CUSTOMER][NEUTRAL] I want to know the status of the claim.
[AGENT][NEUTRAL] OK, I can help you with claim status, sir. Can you please give me your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what's the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] The patient name is [PII]. Date of birth is [PII]. And the member ID is 1804122.
[AGENT][NEUTRAL] OK, let me look up that policy number real quick.
[AGENT][NEUTRAL] OK, I do show the policy. Can you please give me the date of service?
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII] and total charge amount is 591.00.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold, [PII], while I look up this claim for you and I'll be right back.
[CUSTOMER][NEUTRAL] All right. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi [PII], this is [PII] back with you again. So looking for [PII] for data service of [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The claim number is 282-6928.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The claim was denied?
[CUSTOMER][NEUTRAL] Could you please provide me the claim number again?
[AGENT][NEUTRAL] 282-692-8.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Claim was denied because the benefit maximum for the data service was met.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Uh, may I, could you please, uh, fax me the EOB?
[AGENT][NEUTRAL] Yes, sir. I can fax you the EOB. What is your fax number, [PII]?
[CUSTOMER][NEUTRAL] [PII]. Attention ID is 825489.
[AGENT][NEUTRAL] OK and I'm gonna put you on a brief hold while I get that fax ready for you I'll be right back.
[CUSTOMER][NEUTRAL] And may I know, may I know for more information, what is the allowed amount and the paid amount?
[AGENT][NEUTRAL] Let me look.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] The the maximum allowable amount was $500 and that $500 was used up.
[AGENT][NEUTRAL] And maxed out.
[CUSTOMER][NEUTRAL] Uh, the allowed amount is 500. May I know the paid amount?
[AGENT][NEGATIVE] There wasn't anything paid on this claim.
[CUSTOMER][NEUTRAL] OK, so basically there's no paid amount, right? And you said that, uh, may I know the, you said that the claim has been denied for maximum benefit exhausted, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And the metal
[CUSTOMER][NEUTRAL] It is a $1 or a visit.
[AGENT][NEUTRAL] I'm sorry, can you repeat the question?
[CUSTOMER][NEUTRAL] Yeah, so, may I know maximum benefits in terms of dollar or visit?
[AGENT][NEUTRAL] It's, it's in terms of dollar amount, which was $500 and it was maxed out.
[CUSTOMER][NEUTRAL] $500. All right. And how much dollar has patient met excluding this claim?
[AGENT][NEUTRAL] I can't give that information. That's private information.
[CUSTOMER][NEUTRAL] All right, OK, OK, and you fax me the you'll be, right?
[AGENT][NEUTRAL] Yes, sir. I'm gonna fax you the EOB. I'm gonna put you on a brief hold while I take care of that. I'll be right back.
[CUSTOMER][NEUTRAL] All right. You are on hold.
[AGENT][NEUTRAL] Come on computer.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, [PII], I've got that fax on its way to you now.
[CUSTOMER][NEUTRAL] All right. And, and all the balances a patient responsibility.
[AGENT][NEUTRAL] I can't give patient responsibility that's determined by the provider.
[CUSTOMER][NEUTRAL] Alright, and may I know the call reference?
[AGENT][NEUTRAL] Yeah yes sir you can use my name [PII] and today's date.
[CUSTOMER][POSITIVE] Alright, OK, thank you, [PII]. By the way, I'll my lord and bye for now.
[AGENT][POSITIVE] All right, bye-bye, [PII]. You have a good weekend. Thanks for calling APL.
[CUSTOMER][NEUTRAL] Yeah, you too.