AccountId: 011433970860
ContactId: 51503392-d6fc-4b18-bb80-2ba50a14d4df
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 281010 ms
Total Talk Time (AGENT): 118048 ms
Total Talk Time (CUSTOMER): 75310 ms
Interruptions: 1
Overall Sentiment: AGENT=2, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/51503392-d6fc-4b18-bb80-2ba50a14d4df_20250303T13:57_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], my name is [PII]. I'm calling with Puntsville Hospital. Um, I need to get a, uh, full copy of the explanation of benefits or a little, you know, explanation.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, OK well, so you're needing information regarding a claim, is that correct?
[CUSTOMER][NEUTRAL] Um, because
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And [PII], what is a good callback number for you please?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's direct and it's [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please, [PII].
[CUSTOMER][NEUTRAL] Oh shoot, yes, I have 02538913.
[AGENT][NEUTRAL] OK, thank you. Give me a couple moments please to get the member's information pulled up.
[CUSTOMER][POSITIVE] OK thanks.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name please and their date of birth?
[CUSTOMER][NEUTRAL] [PII], um, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the data service place and total bill amount for her?
[CUSTOMER][NEUTRAL] Um, data service $828 2024 total bid amount $66,801.88.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so do you already have the claim number for this one, [PII], or do you need that also?
[CUSTOMER][NEUTRAL] Um, I already have the claim number and I also have an explanation of benefits, but I just don't see where the balance is. I see you paid $0.
[AGENT][NEUTRAL] Correct. OK, so our explanation of benefits are all 2 pages. Now we do not determine patient responsibility. We're not a major medical insurance carrier that would be up for the, to the provider to determine that. Um, the reason for the denial on here states the calendar year maximum.
[CUSTOMER][NEUTRAL] But I don't see this patient that that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For the accident and sickness surgery benefit performed in a hospital, hospital outpatient facility, or freestanding outpatient surgery center has been met for this calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, OK, got you. Yes, I do have the, um, 2 pages. I was just making sure we didn't have anything missing, so, um, that's all I really needed.
[AGENT][NEUTRAL] Oh, OK. Now we also do for future reference if you were to ever need one of our explanation of benefits, [PII], we also have a portal that you should be able to, it's a self registering portal and what you should be able to access that and our website for the portal is secured.
[CUSTOMER][NEUTRAL] And I moved for
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I do.
[CUSTOMER][POSITIVE] Awesome, I will definitely put that in my notes for next time.
[AGENT][NEUTRAL] OK. All right. Well, is there anything else, [PII], that I can help you with this morning?
[CUSTOMER][NEUTRAL] Um, that'll be all. Do you guys do call reference numbers?
[AGENT][NEUTRAL] Yes, you would actually just use my name along with today's date.
[CUSTOMER][POSITIVE] Awesome. Well, that's all I have for today. Thank you so much, [PII].
[AGENT][POSITIVE] Well, you are certainly welcome, [PII], and thank you for calling APL. I hope you have a very nice and safe day.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][POSITIVE] Yes, ma'am. Bye-bye. Thank you.
[CUSTOMER][NEUTRAL] Mhm