AccountId: 011433970860
ContactId: 33bac112-70d5-4759-a47b-5ee295850ded
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 350820 ms
Total Talk Time (AGENT): 91268 ms
Total Talk Time (CUSTOMER): 124822 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/33bac112-70d5-4759-a47b-5ee295850ded_20250521T12:27_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yes, good morning, [PII]. My name is [PII]. I'm calling from Geisinger Clinic, and I'm checking on claim status for a member, please.
[AGENT][NEUTRAL] OK. Do you have a phone number I can get in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] Yes, [PII] and it's a direct line.
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] It's D as in dog, 433-02256.
[AGENT][NEUTRAL] That's not one of our policy numbers. Do you have their social security number?
[CUSTOMER][NEUTRAL] Uh, let's see, let's see if I can get that for you.
[CUSTOMER][NEUTRAL] Um, yes. I, I do have [PII].
[AGENT][NEUTRAL] Thank you [PII], hold on one moment please.
[CUSTOMER][NEUTRAL] Of course.
[AGENT][NEUTRAL] What's the patient's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And this is on medical.
[CUSTOMER][NEUTRAL] It is, yes.
[AGENT][NEUTRAL] And what's his date of birth?
[CUSTOMER][NEUTRAL] Uh, let me check that for you.
[CUSTOMER][NEUTRAL] Um, he was born [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And you were just needing claim status?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][POSITIVE] OK, I can help you with that one.
[CUSTOMER][NEUTRAL] Was that the incorrect?
[CUSTOMER][NEUTRAL] Was that the incorrect subscriber ID?
[AGENT][NEUTRAL] It is. That's for their wellness policy. This is their sickness policy. The policy number is 02.
[AGENT][NEUTRAL] 57
[AGENT][NEUTRAL] 2295.
[CUSTOMER][NEUTRAL] OK, and that is for sickness benefits, you said?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the date of service?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And it is for $1070.
[CUSTOMER][NEUTRAL] And we received um
[CUSTOMER][NEUTRAL] An EOP, but it said it was a duplicate. We don't have a record of the original claim, please.
[AGENT][NEUTRAL] OK. Was this for a hospital bill, doctor's charge?
[CUSTOMER][NEUTRAL] A doctor's charge.
[AGENT][NEUTRAL] What was that procedure?
[CUSTOMER][NEUTRAL] And um, it looks like it's um.
[CUSTOMER][NEUTRAL] 99285 an emergency room visit.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][POSITIVE] You're welcome, sure.
[AGENT][NEUTRAL] OK, yes, ma'am. We did get it in. It was denied for benefit maximum for this data service has been met.
[CUSTOMER][NEUTRAL] OK. Be maximum for, for what, ma'am?
[AGENT][POSITIVE] This data service has been met.
[CUSTOMER][NEUTRAL] Is it patient responsibility?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And what is the claim number, ma'am?
[AGENT][NEUTRAL] 3571427.
[CUSTOMER][NEUTRAL] Please.
[CUSTOMER][POSITIVE] Thank you. All right, and what was the process?
[AGENT][NEUTRAL] Hold on just a moment, I tell you.
[CUSTOMER][POSITIVE] Thank you very much.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Hold one moment.
[AGENT][NEUTRAL] OK, it was processed 3525.
[CUSTOMER][NEUTRAL] OK, great. Is there any way I can get a copy of the explanation of payment emailed to me?
[CUSTOMER][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] I can fax it to you.
[CUSTOMER][POSITIVE] That will be perfect.
[AGENT][NEUTRAL] OK, what is your fax number?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And if you could put attention, [PII] and my last name is [PII]
[AGENT][NEUTRAL] OK. I will fax that to you. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Um, just your reference number, please.
[AGENT][NEUTRAL] We do not have reference numbers. You can use my name and today's date.
[CUSTOMER][POSITIVE] Perfect. Thank you very much, [PII]. You have a great weekend and a better holiday weekend.
[AGENT][POSITIVE] Thank you, [PII] for calling APL you as well.
[CUSTOMER][POSITIVE] Thank you very much. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.