AccountId: 011433970860
ContactId: 3212711e-220a-4a71-a490-f7cb2a9be1f5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 625239 ms
Total Talk Time (AGENT): 100747 ms
Total Talk Time (CUSTOMER): 108080 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/3212711e-220a-4a71-a490-f7cb2a9be1f5_20250224T15:12_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from Massey Hospital, looking for a claim status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Can I please get your callback number?
[CUSTOMER][NEUTRAL] Uh, it's [PII]. I'm sorry, I missed your name. Can I have your name, please?
[AGENT][NEUTRAL] Yes, my name is [PII]
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][POSITIVE] Thank you and [PII] what is.
[AGENT][NEUTRAL] The date of birth and policy number.
[CUSTOMER][NEUTRAL] Policy number 020.
[CUSTOMER][NEUTRAL] 18413
[CUSTOMER][NEUTRAL] Patient's date of birth is [PII].
[AGENT][NEUTRAL] And what is the patient's name?
[CUSTOMER][NEUTRAL] [PII]. Date of birth.
[AGENT][NEUTRAL] OK, thank you, let me pull this policy up real quick.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, can I please get the data service and the charge amount?
[CUSTOMER][NEUTRAL] Um, first day of service, [PII].
[CUSTOMER][NEUTRAL] And the bill amount $389 even.
[AGENT][NEUTRAL] OK, and then what is the charge after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Ah, I have to.
[CUSTOMER][NEUTRAL] Just give me a moment please. I have to open the primary UP.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Primary process the claim towards the deductible.
[CUSTOMER][NEUTRAL] We have two line items. The 1st 1 8651 2 plus.
[CUSTOMER][NEUTRAL] 65.52.
[CUSTOMER][NEUTRAL] Uh, yeah, uh, primary process towards a deductible of $151.64.
[AGENT][NEUTRAL] OK and you from Mercy Hospital, is that correct?
[CUSTOMER][POSITIVE] Yes, you're right.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold [PII] while I look up this claim for us and I'll be right back.
[CUSTOMER][POSITIVE] Sure, thank you.
[AGENT][POSITIVE] Thank you, sir.
[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][NEUTRAL] For holding for me, [PII], I did find the claim.
[AGENT][NEUTRAL] The claim number is 324-8553. The claim was received on [PII]. It was processed on [PII], and the claim was denied because there are no benefits for the pregnancy of a dependent child.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And there is no coverage for the new one, is it?
[AGENT][NEUTRAL] Right, right. No, non-covered for pregnancy of dependent child.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Alright, thank you. Mm, so.
[CUSTOMER][NEUTRAL] Is it possible to fax that you?
[AGENT][NEUTRAL] Yes, I can fax the EOB. Um, may I get your fax number?
[CUSTOMER][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] Fax number [PII].
[CUSTOMER][NEUTRAL] Attention my name, [PII].
[AGENT][NEUTRAL] OK and I'm gonna put you on a brief hold while I fax this over to you and I'll be right back.
[CUSTOMER][POSITIVE] Sure, thank you.
[AGENT][POSITIVE] Thank you, [PII].
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you [PII] for holding for me. I have that fax on its way to you now.
[CUSTOMER][POSITIVE] Thank you so much. Is there a call reference number for this call?
[AGENT][NEUTRAL] Yes, sir, you can use my name. It's [PII] and today's date.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] That's all. Thank you so much for your time and patience story. Have a wonderful day. Bye now.
[AGENT][POSITIVE] You too [PII] thank you for calling APL you have a great day also. Bye bye sir.
[CUSTOMER][NEUTRAL] Right.