AccountId: 011433970860
ContactId: 408c5ecd-5e39-41fc-80e3-7958558454e6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 213100 ms
Total Talk Time (AGENT): 84408 ms
Total Talk Time (CUSTOMER): 54636 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/408c5ecd-5e39-41fc-80e3-7958558454e6_20250320T18:56_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name's [PII]. I'm calling from Prisma Health, um, University Medical Group calling to check claim status on a claim.
[AGENT][NEUTRAL] OK, and [PII], what is your callback number please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] What is the policy number please, [PII]?
[CUSTOMER][NEUTRAL] It is 02351181.
[AGENT][POSITIVE] Thank you and to repeat that I have that as 02351181.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] Thank you very much for the verification process called for claim status. I can assist you with that data service and the total charge.
[CUSTOMER][NEUTRAL] It is um.
[CUSTOMER][NEUTRAL] [PII] for 226.
[AGENT][NEUTRAL] 226 for [PII]. 1 moment, thank you.
[AGENT][NEUTRAL] 6
[AGENT][NEUTRAL] OK, shows that the claim was received and denied. Give me one moment to get that reason why it was denied. [PII], one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Was this an ER visit?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you. Um, part of the policy, he does not have benefits for an ER. Um, the policy covers hospital confinement and surgery but not.
[AGENT][NEUTRAL] Services in an ER.
[CUSTOMER][NEUTRAL] Just hospital.
[AGENT][NEUTRAL] Yes, hospital confinement, yes.
[CUSTOMER][NEUTRAL] Inpatient.
[AGENT][NEUTRAL] And surgery.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] In the facility or physician's office.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Would you like that claim number?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] I would love that claim number.
[AGENT][NEUTRAL] OK, it is 3576693.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Where can I get that EOB that shows up?
[AGENT][NEUTRAL] OK, um, you're able to check claims status on our secure website at [PII]. You'll be able to obtain that you'll be from the website.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and a call reference number?
[AGENT][NEUTRAL] We do not use call reference numbers, [PII], but you can use my name [PII] last initial is [PII] and today's date.
[CUSTOMER][POSITIVE] OK, thank you for your help.
[AGENT][POSITIVE] You're welcome, [PII]. Thank you for calling APL and take care. You too, bye.
[CUSTOMER][POSITIVE] Have a good day. All right, bye bye.