AccountId: 011433970860
ContactId: 31e4cf1f-9a48-486a-9373-51cee26bb6e1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 365459 ms
Total Talk Time (AGENT): 88308 ms
Total Talk Time (CUSTOMER): 101624 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/31e4cf1f-9a48-486a-9373-51cee26bb6e1_20250217T21:24_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from Prisma Health. I am calling to status and claim that has denied.
[AGENT][NEUTRAL] OK, sure, Ms. [PII], I can assist you with claims.
[AGENT][NEUTRAL] And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it is [PII], no extension.
[AGENT][NEUTRAL] OK. Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Oh yes, D as in David, 43728858.
[AGENT][NEUTRAL] Do you see a policy certificate number? It's gonna start with a 0 followed by 7 digits. That's gonna be our number.
[CUSTOMER][NEUTRAL] Uh, OK, so benefits in a car just transferred me to you. Let me see if I can find another number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I don't see that number on the card.
[AGENT][NEUTRAL] OK, um, we can do a name search. Um, what's the spelling of the last name?
[CUSTOMER][NEUTRAL] The spelling of the last name is [PII], that's [PII].
[AGENT][NEUTRAL] OK. And what is the spelling of the first name?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you and let me see if I can find this number. One moment.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Do you have an address for Ms. [PII]?
[CUSTOMER][NEUTRAL] I do. It is [PII], that's in [PII].
[AGENT][NEUTRAL] Mm OK.
[AGENT][NEUTRAL] Let me try this 11 moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What's her date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, found her alright and what is the claim number or the date of service?
[CUSTOMER][NEUTRAL] Claim number is 3503247.
[AGENT][NEUTRAL] OK. Thank you. Let me put the image on that plane. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] I'm still waiting. I'm sorry. I'm still waiting on the image.
[CUSTOMER][NEUTRAL] No, you're fine.
[AGENT][POSITIVE] Thank you for your patience.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] And this was for data service [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. All right. So this particular claim was denied because the only outpatient service that we cover is surgery.
[CUSTOMER][POSITIVE] OK. Awesome. Would you be able to check one more day for this patient for me?
[AGENT][NEUTRAL] Sure, what is the date of service?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] I don't see a claim for that date of service.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Let me make sure it's not a date range, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, I've got a claim number or uh.
[CUSTOMER][NEUTRAL] It's a it's a loan claim number. It looks like it may be a benefits and card claim number. Um hm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. um, thank you so much for your help. I appreciate it.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that's it. Thank you.
[AGENT][POSITIVE] Welcome, Ms. [PII] and thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][POSITIVE] Thank you. Bye bye.