AccountId: 011433970860
ContactId: 41e0cd39-3415-449b-ab89-9097728313cd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 580580 ms
Total Talk Time (AGENT): 125865 ms
Total Talk Time (CUSTOMER): 94403 ms
Interruptions: 1
Overall Sentiment: AGENT=1.9, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/41e0cd39-3415-449b-ab89-9097728313cd_20250513T14:20_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office, and I've actually one game on which I have to check the status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Um, may I please get your callback number just in case the call is disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, sir. And what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Patient policy number is 025.
[CUSTOMER][NEUTRAL] 102
[CUSTOMER][NEUTRAL] 81.
[AGENT][NEUTRAL] And the member's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, member's name is uh [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, let me pull in that policy real quick.
[AGENT][NEUTRAL] And then can you please give me the data service and the charge amount?
[CUSTOMER][NEUTRAL] D of service [PII] charges are.
[CUSTOMER][NEUTRAL] Uh, let me check, it's $27,0007.17.
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] Thank you, sir. And then what is the name of the facility you're calling from, sir?
[CUSTOMER][NEUTRAL] Facility is uh Wellmont Health system, also known as Houston Valley Medical Center.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold, [PII], while I look up this claim for us and I'll be right back.
[CUSTOMER][POSITIVE] Take your time.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me, [PII]. I have the claim information for you. The claim number is 3546932.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And the claim was denied because the calendar year maximum for the accident and sickness surgery benefit performed in a hospital, outpatient facility or freestanding outpatient surgery center has been met for the calendar year.
[CUSTOMER][NEUTRAL] So the maximum benefits has been raised for the calendar year, right?
[AGENT][POSITIVE] Yes, sir. You're right.
[CUSTOMER][NEUTRAL] And is it the patient responsibility?
[AGENT][NEUTRAL] We don't give patient responsibility. We let the provider determine that.
[CUSTOMER][NEUTRAL] So can you please fax the EOB then?
[AGENT][NEUTRAL] Yes, sir. What's your fax number?
[CUSTOMER][NEUTRAL] Just give me a moment. I will provide you that.
[AGENT][POSITIVE] Yes sir, take your time.
[CUSTOMER][NEUTRAL] I don't remember it actually yeah thanks.
[AGENT][POSITIVE] OK, that's all right. You take your time.
[CUSTOMER][NEUTRAL] Just give me a moment, it's currently loading.
[AGENT][NEUTRAL] OK, that's fine.
[CUSTOMER][POSITIVE] Thanks.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] So it's 513.
[CUSTOMER][NEUTRAL] 964
[CUSTOMER][NEUTRAL] 6812.
[AGENT][NEUTRAL] OK, let me repeat it. 513-9646812, is that correct?
[CUSTOMER][NEUTRAL] Yep.
[AGENT][POSITIVE] OK, I'm gonna put you on a quick hold again so I can get this fax ready for you and I'll be right back sir.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hm.
[AGENT][POSITIVE] And I haven't forgot about you. It's loading right now. It'll be there shortly. It's gonna be just another minute. I just wanna let you know I didn't forget about you.
[CUSTOMER][NEUTRAL] Sure. Meanwhile, what's the spelling of your name?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] It's gonna be a brief hold again thank you.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh, I actually was just breaking in between actually, sorry to, uh, tell you that, but, uh, is it [PII] or [PII] in the beginning?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Oh, it's got it, thanks.
[AGENT][POSITIVE] You're welcome. It's gonna be a quick hold again, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me. I have that fax on its way to you now.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, what's the call reference?
[AGENT][NEUTRAL] It will be my name and today's date.
[CUSTOMER][POSITIVE] All right, [PII], thank you so much for helping me out today and yeah, you do have a good one. Bye-bye.
[AGENT][POSITIVE] You have a wonderful day too, [PII], and thank you for calling APL sir. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye bye bye.