AccountId: 011433970860
ContactId: 1a38b3c7-2959-4fcb-9b76-fc9c4b0b9967
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 497260 ms
Total Talk Time (AGENT): 121559 ms
Total Talk Time (CUSTOMER): 58134 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/1a38b3c7-2959-4fcb-9b76-fc9c4b0b9967_20250410T18:45_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, I'm trying to get a claim status.
[AGENT][NEUTRAL] OK, sure. I can assist you with claim status. May I have your name?
[CUSTOMER][NEUTRAL] My name is [PII] What was your name?
[AGENT][NEUTRAL] My name is [PII], last initial [PII].
[AGENT][NEUTRAL] Mr. [PII], may I have a callback number just in case we get disconnected?
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] No, it's [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And may I have the name of the facility you're calling from, Sky?
[CUSTOMER][NEUTRAL] Yes, I'm calling from Saint Joseph's Hospital.
[AGENT][NEUTRAL] All right, and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 02495934
[AGENT][NEUTRAL] OK. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Alright, thank you. What's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Date of service is $2125. The amount $1,047.
[AGENT][NEUTRAL] OK, let me see if I can find this claim for you and for future, you can check claim status online through our website at [PII], and that's just optional and bear with me, let me pull this EOB, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm still waiting on the paperwork, OK?
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Thank you for your patience.
[AGENT][NEUTRAL] OK. So it looks like we processed the claim on [PII] and the claim was denied. The reason for this denial is indicating the policy covered treatment by a physician to cover sickness in the physician's office, clinic, urgent care, or emergency room. So there's no outpatient facility benefits under this policy unless it's one of those mentioned.
[CUSTOMER][NEUTRAL] All righty. um, is it a way for me to get a copy of that ELP?
[AGENT][NEUTRAL] Um, yes, what is the fax number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] To your attention it's OK.
[CUSTOMER][NEUTRAL] And do you have a car? Yes, that's fine.
[AGENT][NEUTRAL] OK. Do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold so I can send it right now, OK? One moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for you, Mr. [PII]. Yeah, I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I'm gonna help you with today?
[CUSTOMER][NEUTRAL] Do you have a claim number?
[AGENT][NEUTRAL] Yes, the claim number is.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] 356-674-1
[CUSTOMER][NEUTRAL] Alrighty, and can I get a call reference?
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's date if you will.
[CUSTOMER][POSITIVE] Alrighty thank you have a great day.
[AGENT][POSITIVE] Mhm you as well. Thank you for calling APO.