AccountId: 011433970860
ContactId: 253dfbbe-6195-475e-8eba-d17dc6401d21
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 247500 ms
Total Talk Time (AGENT): 93398 ms
Total Talk Time (CUSTOMER): 54055 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/253dfbbe-6195-475e-8eba-d17dc6401d21_20250117T14:03_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling for claim status.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the claim status. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] It is [PII] last name initial [PII], the callback number [PII].
[AGENT][NEUTRAL] Thank you for that. And [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 02249656 M like Mike L like Lima 7
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Thank you for that. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And may I have the date of service for the claim you like me to check on?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] $2,433.
[AGENT][NEUTRAL] All right, thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And it is [PII].
[AGENT][NEUTRAL] And [PII], do you mind if I place you on just a brief hold while I locate the claim?
[CUSTOMER][POSITIVE] And that's fine, thank you.
[AGENT][NEUTRAL] You're welcome. Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So I do see that we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 350.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 3894.
[AGENT][NEUTRAL] And on [PII], the claim was denied?
[AGENT][NEUTRAL] Because the inpatient benefit for the calendar year has been met.
[CUSTOMER][NEUTRAL] I'm sorry, what was the reason?
[AGENT][NEUTRAL] The inpatient benefit for the calendar year has been met?
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] The last thing, may I have a call reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date, and that's [PII], first [PII] to my last name is [PII], and then today's date.
[CUSTOMER][NEUTRAL] OK, thanks for that. My very last question just to clarify, is the whole denied amount of the $1300.04 the patient responsibility?
[AGENT][NEUTRAL] So we don't determine patient responsibility because we're not the major medical, um, so the outstanding balance would be between primary and the provider to determine.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you for your help.
[AGENT][POSITIVE] You're welcome and thanks for calling APL. I hope you have a good day and have a great weekend.
[CUSTOMER][POSITIVE] Thank you you too. I hope you enjoy your weekend bye bye.
[AGENT][POSITIVE] You're welcome. Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Mm.