AccountId: 011433970860
ContactId: 363d06db-5f38-4109-b2a7-9150e9da4ce8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 248300 ms
Total Talk Time (AGENT): 105046 ms
Total Talk Time (CUSTOMER): 68388 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/363d06db-5f38-4109-b2a7-9150e9da4ce8_20250204T19:40_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. I'm with Baptist Health Medical Group. I'm calling to get more information on a claim that denied.
[AGENT][NEUTRAL] I'm sure [PII] I can assist you with claim status. First, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, my direct line is [PII].
[AGENT][NEUTRAL] OK. Thank you. Now, I need the policy number, please.
[CUSTOMER][NEUTRAL] Um, 02350172.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. Now, I need the date of service and bill charges on the claim.
[CUSTOMER][NEUTRAL] OK, 814 $24 build out $44.
[AGENT][NEUTRAL] In one moment, I'm still waiting on my system.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yes, we received this claim on [PII] and processed on [PII].
[AGENT][NEUTRAL] And the claim denied because under this policy for outpatient benefits, we cover up to, let's see.
[AGENT][NEUTRAL] We cover up to 1000 per calendar year and that benefit was maxed out on a previous claim.
[CUSTOMER][NEUTRAL] OK, so this is ER, so is that separate or is that included in the outpatient?
[AGENT][NEUTRAL] Yes, it's included in the outpatient.
[CUSTOMER][NEUTRAL] OK, um
[CUSTOMER][NEUTRAL] OK, so there's not a separate benefit for ER?
[AGENT][NEUTRAL] No, ma'am, there isn't.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So would this be patient responsibility or who, who would cover this?
[AGENT][NEUTRAL] Um, yes, ma'am. It will be patient responsibility with their secondary gap insurance and the benefit maxed out, so.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It will be, yeah.
[CUSTOMER][NEUTRAL] Do you have um.
[CUSTOMER][NEUTRAL] Like the date when it the benefit max.
[AGENT][POSITIVE] Yes, ma'am, let me get that for you.
[AGENT][NEUTRAL] Um, the date of service for the claim was [PII].
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] And it maxed out on [PII].
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] OK, so this was in August, so that was the the date of service, so.
[CUSTOMER][NEUTRAL] It maxed out before then.
[AGENT][NEUTRAL] Well, um,
[AGENT][NEUTRAL] Well, I gave you the date of service for the claim. I should have gave you the date of service um when it maxed out in our system. It maxed out in our system on [PII], and we processed the claim. Well, we received the claim and processed it on [PII].
[CUSTOMER][NEUTRAL] OK, so it processed or it maxed out just before you got the client.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, all right. Um, and then may I have a reference number to document this?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date. My name is [PII]. It's spelled [PII] and my last initial is [PII] and today's date. Um, is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Nope, that was all I needed.
[AGENT][POSITIVE] OK. Well, I thank you again, [PII] for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][POSITIVE] You too. Thank you.
[AGENT][POSITIVE] Thank you.