AccountId: 011433970860
ContactId: 192e530b-2304-4cc2-8800-7abd7ea4e456
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 511329 ms
Total Talk Time (AGENT): 151103 ms
Total Talk Time (CUSTOMER): 285380 ms
Interruptions: 9
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/192e530b-2304-4cc2-8800-7abd7ea4e456_20250423T12:26_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] For calling APL. This is
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from Ana Medical Center looking for a claim status. By the way, what is your name? Could you please spell it for my documentation purpose?
[AGENT][NEUTRAL] It, sure, it's [PII] and first initial of your last name is [PII]. And [PII], how do you spell your name?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] My name is [PII]. It's [PII].
[AGENT][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] And can you provide the policy number?
[CUSTOMER][NEUTRAL] Yes, it's 024.
[CUSTOMER][NEUTRAL] 056
[CUSTOMER][NEUTRAL] 07.
[AGENT][NEUTRAL] And many did you say you're checking claim status or you need benefits?
[CUSTOMER][NEUTRAL] Uh, for the claim status for this patient.
[AGENT][NEUTRAL] OK, what's your callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, the patient name is [PII]. [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Well.
[CUSTOMER][NEUTRAL] Let.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK, [PII], what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] It's [PII], [PII].
[AGENT][NEUTRAL] OK, and what's the date of service of her claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] No, [PII].
[AGENT][NEUTRAL] 3.
[AGENT][NEUTRAL] OK. And what's the total charge?
[CUSTOMER][NEUTRAL] $1,226 and the pending amount after primary process is $547.
[AGENT][NEUTRAL] I just need the total bill right now.
[CUSTOMER][NEUTRAL] OK. $1,226 even.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And so is this a hospital claim?
[CUSTOMER][NEUTRAL] Uh yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] that.
[CUSTOMER][NEUTRAL] 70.
[AGENT][NEUTRAL] And what's the name of the hospital, uh, [PII]?
[CUSTOMER][NEUTRAL] It's Medical Center.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And was that for speech or physical therapy?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh yes.
[AGENT][NEUTRAL] Which one?
[AGENT][NEUTRAL] Which service was provided?
[CUSTOMER][NEUTRAL] It's occupational therapy.
[AGENT][NEUTRAL] OK, so I do show that the claim was received on [PII].
[CUSTOMER][NEUTRAL] I put it
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Processed [PII].
[CUSTOMER][NEUTRAL] That's.
[AGENT][NEUTRAL] And occupational therapy is not covered by this policy, so there was no payment made. I do have the claim num excuse me, I do have the claim number. Let me know when you're ready.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Allow me a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh yes, please.
[AGENT][NEUTRAL] That number is 350.
[AGENT][NEUTRAL] 7248.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's the claim number and did you have any other questions?
[CUSTOMER][NEUTRAL] Uh yes. Could you please, uh, mail us the explanation of benefits for this patient because uh we want, uh, denial EOB from your site.
[AGENT][NEUTRAL] OK, so whenever the claim is processed, the EOB is automatically mailed to the address on your claim, so it is now available for you to download on our online service center. um, I can help you set that account up if you would like.
[CUSTOMER][NEUTRAL] Uh, but we don't, uh, receive any year before this patient. If, uh, you can fax me, please fax.
[AGENT][NEUTRAL] I understand, I understand it was mailed they're generated automatically and so we can set up an account and then I can show you how to download the ELB from our um website.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so how much time it will take to uh get a COB?
[AGENT][NEUTRAL] To set up the account?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] It doesn't take long.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So where can we find the EOB right now?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Where we can, uh, is there any uh any website where we can find the
[AGENT][NEUTRAL] OK, let me give you the let me give you the let me give you the web address.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Let me know when you're ready.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the first word is secured SEC.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, letter [PII].
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII], right?
[AGENT][NEUTRAL] Uh, [PII]
[CUSTOMER][NEUTRAL] Mhm
[AGENT][POSITIVE] And the rest is correct.
[CUSTOMER][NEUTRAL] Ah, OK.
[CUSTOMER][NEUTRAL] So you can't send through fax, right? No.
[CUSTOMER][NEUTRAL] Uh, may I have your call reference number for this patient?
[AGENT][NEUTRAL] It's my name in today's date, [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Your phone number?
[AGENT][NEUTRAL] And first initial last name is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, is there any possibility to access the EOB?
[AGENT][NEUTRAL] Your fax number?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] 488-5570
[AGENT][NEUTRAL] OK, anything else I can help out with today, [PII]?
[CUSTOMER][POSITIVE] Uh, no, thank you so much for providing me all the information.
[AGENT][POSITIVE] You're welcome and thank you for calling APL have a good day.
[CUSTOMER][POSITIVE] Bye-bye. Thank you so much.
[AGENT][NEUTRAL] Uh-huh.