AccountId: 011433970860
ContactId: 51a4f3f0-3cdc-402f-89a6-4cd90621c250
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 217279 ms
Total Talk Time (AGENT): 54982 ms
Total Talk Time (CUSTOMER): 107068 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/51a4f3f0-3cdc-402f-89a6-4cd90621c250_20250522T21:21_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII], and I'm calling from the business office of CHI Health Creighton University Medical Center and Mercy checking for claims. This call is recorded and monitored for quality assurance.
[AGENT][POSITIVE] I'd be happy to assist with the claim status today and if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] [PII] direct line. I'm sorry, how do you spell your name?
[AGENT][NEUTRAL] [PII], last initial is [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] I'm sorry, can you repeat that, please?
[AGENT][NEUTRAL] What is the policy number?
[CUSTOMER][NEUTRAL] 02463395.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And what is the date of service?
[CUSTOMER][NEUTRAL] [PII]. And that is for $1,696.
[AGENT][NEUTRAL] Thank you for that information. I'm showing the claim was denied because the maximum outpatient benefit had already been met prior to receiving this claim.
[CUSTOMER][NEUTRAL] Has benefit has been met prior to, sorry, prior to receiving this claim. Am I correct?
[AGENT][NEUTRAL] Right, by the time we received your claim they had already maxed out their outpatient benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Maxed out.
[CUSTOMER][NEUTRAL] Outpatient benefits. OK.
[CUSTOMER][NEUTRAL] Um, what is the received date and then I'll date for this claim, [PII]?
[AGENT][NEGATIVE] We received the claim on [PII], claim denied on [PII].
[CUSTOMER][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] And will it be patient responsibility?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Since this famous the night. OK. All right.
[CUSTOMER][NEUTRAL] Will be member responsibility. Um, what is the claim number?
[AGENT][NEUTRAL] Claim number is 360-1948.
[CUSTOMER][NEUTRAL] Thank you. Um, before we bill the patient, I would like to request for the EOB to be faxed.
[AGENT][NEUTRAL] OK, what's that fax number?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Can I get that number after the attention again please?
[CUSTOMER][NEUTRAL] Uh yes, uh, with attention to [PII].
[AGENT][POSITIVE] Thank you for that.
[AGENT][NEUTRAL] You should receive that within the next 10 to 15 minutes. Was there anything else I can assist with today?
[CUSTOMER][NEUTRAL] Uh, no, [PII], thank you for your help. I just need to get a call reference number.
[AGENT][NEUTRAL] Reference is just my name [PII] last initial S as [PII], and the date and time of the call.
[CUSTOMER][POSITIVE] OK, thank you. Goodbye. You have a great day.
[AGENT][POSITIVE] Thank you for