AccountId: 011433970860
ContactId: 239ffec6-ec71-4472-b1de-f1bff904450f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 351200 ms
Total Talk Time (AGENT): 179699 ms
Total Talk Time (CUSTOMER): 75787 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/239ffec6-ec71-4472-b1de-f1bff904450f_20250129T20:58_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from a provider's office to check status of a claim.
[AGENT][POSITIVE] OK, [PII], I'd love to help you with that today. And do you mind if I snag a quick, uh, I'm so sorry, a quick call back number for you.
[CUSTOMER][NEUTRAL] Mhm. [PII], no extension.
[AGENT][NEUTRAL] Thank you. And then the member's policy number, please?
[CUSTOMER][NEUTRAL] That is 253-916-6.
[AGENT][POSITIVE] Perfect. Give me a second to get that loaded.
[AGENT][NEUTRAL] And would you be able to verify for me, please, that insured's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Perfect.
[AGENT][POSITIVE] Alrighty.
[AGENT][NEUTRAL] And did you have a particular claim number you wanted to look at further or you want me to search for it with your data service?
[CUSTOMER][NEUTRAL] Um, data service is 924-24.
[AGENT][POSITIVE] Perfect. And the bill amount?
[CUSTOMER][NEUTRAL] $527.
[AGENT][NEUTRAL] Alright, give me a second to look into that for you, my friend.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the name of the facility on file for this one?
[CUSTOMER][NEUTRAL] Mount Carmel, Saint Anne's.
[AGENT][NEUTRAL] Alright, I do see that right here. I show that your claim with us was received on [PII]. It looks like it was processed [PII].
[AGENT][NEUTRAL] I do show your claim number listed as 3545465.
[AGENT][NEUTRAL] And it looks like that claim did deny. I do have the reason stating that
[AGENT][NEUTRAL] So sorry, let me read this for you. It's kinda long. Uh, the medical test for this state of service is not a covered diagnostic test and therefore no benefit is payable for this claim. Covered tests include an MRI, a CAT scan, a thyroid uptake, uh, a CT, PET scan, angiogram, barium enema, or lower GMI. I said GMI but GI series. I'm sorry.
[AGENT][NEUTRAL] Myelogram nuclear stress test, test. I can, I'm so sorry. I don't know why I can't say anything today.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh no, it's OK
[AGENT][NEUTRAL] Um, audiogram, barium swallow, upper GI series, sleep study or a TEE?
[CUSTOMER][NEUTRAL] OK, and has the remit or denial went out to the provider?
[AGENT][NEUTRAL] Uh, yes, that should have been sent out um on the [PII] for you, but I can fax it if you haven't received it yet.
[CUSTOMER][POSITIVE] Oh, yes, that would be perfect. Um, my
[AGENT][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Fax number is [PII].
[AGENT][NEUTRAL] Oh goodness. OK. I thought I typed that and it was all going somewhere, but I, I typed it into the nothingness. [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] All right, perfect.
[AGENT][NEUTRAL] And do you want that made attention to yourself, Ms. [PII]?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Close, [PII]
[AGENT][POSITIVE] EKA. OK, perfect.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And just one second for that dialog box to load on the fax portion.
[AGENT][POSITIVE] You having a great day so far?
[CUSTOMER][POSITIVE] Oh, yeah, it's been pretty cool today.
[CUSTOMER][NEUTRAL] Not too hectic or anything.
[AGENT][NEUTRAL] Like cool like fun or cool like cold?
[CUSTOMER][POSITIVE] Um, cool, like.
[CUSTOMER][NEUTRAL] Lay back, relaxed, not.
[AGENT][NEUTRAL] So, OK.
[CUSTOMER][NEUTRAL] I will work or something to the back.
[AGENT][NEUTRAL] It's been freezing in my home today, so I'm like cool in the bad way.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Oh yeah, the temperature is pretty cool today. I think it's in the 40s. I'm in [PII].
[AGENT][NEUTRAL] Oh, OK, I'm [PII] based. It was like almost 60 degrees yesterday and then it's in the 40s today, and it's a big difference.
[CUSTOMER][NEUTRAL] Oh, OK, I get it. Yeah, I'm originally from [PII], so it's.
[CUSTOMER][POSITIVE] So this 45 degrees is, it's pretty comfortable compared to what it's been.
[AGENT][POSITIVE] It's nice.
[AGENT][POSITIVE] Alright, Ms. [PII], I was able to hit send on that fax for you. You should be getting it any time now. Is there anything else I can do to take care of you today?
[CUSTOMER][NEUTRAL] A reference number if there's one.
[AGENT][NEUTRAL] Oh, yeah, it's my name, [PII], first initial, last name, [PII], and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK thank you you have a good day.
[AGENT][POSITIVE] Hey, it's my pleasure. Thank you. You take care.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye.