AccountId: 011433970860
ContactId: 52656813-0c53-4842-90dc-e87d8125282a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 247690 ms
Total Talk Time (AGENT): 91995 ms
Total Talk Time (CUSTOMER): 54832 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/52656813-0c53-4842-90dc-e87d8125282a_20250528T15:13_UTC.wav
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[AGENT][POSITIVE] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII] calling from Mercy Hospital, checking on a claim status.
[AGENT][NEUTRAL] I'm sure, [PII] I can assist you with claim status. Um first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. Now, I need the policy number, please.
[CUSTOMER][NEUTRAL] It is D as in Delta 445-04814.
[AGENT][NEUTRAL] OK, that's not one of our policy numbers. Do you have the member's name or social?
[CUSTOMER][NEUTRAL] And the social is [PII].
[AGENT][NEUTRAL] OK, one moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK and please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] OK. The patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Uh yes, ma'am. I found her in our system. Would you like her policy number?
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] Um, her policy number is 02582808.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what's the date of service and bill charges on the claim you're calling about?
[CUSTOMER][NEUTRAL] Date of service is [PII]. The amount is $155 even.
[AGENT][NEUTRAL] OK, I'm waiting on my system. One moment, please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, yes, ma'am. I'm showing that that claim number is.
[AGENT][NEUTRAL] 356.
[AGENT][NEUTRAL] 357 3.
[AGENT][NEUTRAL] We received the claim on [PII].
[AGENT][NEUTRAL] And it processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And it's denying because the place of service is not covered under the policy.
[CUSTOMER][NEUTRAL] On the member's policy?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] So we can bill the balance to the member.
[AGENT][POSITIVE] Yes, ma'am, you can.
[CUSTOMER][NEUTRAL] Can you please fax the EOP?
[AGENT][NEUTRAL] Um, yes, I can fax it to you. What's your fax number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And so whose attention?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, so that's attention, [PII] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. You should receive the fax in about 10 minutes. Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Can you please spell your name?
[AGENT][NEUTRAL] Um, my name is spelled [PII] and your reference number will be my name and today's date.
[CUSTOMER][POSITIVE] Thank you for providing information. Have a nice day. Bye-bye.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling APL. Mm bye.