AccountId: 011433970860
ContactId: 545cf4a4-4ef4-4b02-b9e8-c9f2159a47ee
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 478200 ms
Total Talk Time (AGENT): 102091 ms
Total Talk Time (CUSTOMER): 108369 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/545cf4a4-4ef4-4b02-b9e8-c9f2159a47ee_20250312T17:42_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 on behalf of Henry Ford Hospital to check on a claim denied status.
[AGENT][NEUTRAL] OK, I can help you with claim status Visa. Can I please get your callback number?
[CUSTOMER][NEUTRAL] [PII] with extension [PII].
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Mhm thank you. And then what's the patient's name, date of birth, and
[CUSTOMER][NEUTRAL] And your name is [PII], right?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yeah, the patient name is [PII], and the last name is [PII]
[AGENT][NEUTRAL] OK, and [PII]'s date of birth and policy number please?
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] And may I have the policy number please?
[CUSTOMER][NEUTRAL] It's 025.
[CUSTOMER][NEUTRAL] 43083.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's 02543083?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me look up that policy real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you, and then can you please give me the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII] and the charge amount is $4,485.49.
[AGENT][NEUTRAL] OK and then what is the name of the facility you're calling from?
[CUSTOMER][POSITIVE] It's a handy for the hospital.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold, [PII]. Now you said that the claim was denied. What is the claim number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, the claim number is 352-869-9.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I look up that claim and I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you [PII] for holding for me. So I did find the claim and the claim was denied because the benefit maximum for that had been maxed out for the calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you please come again? It's one per calendar year.
[AGENT][NEUTRAL] Right, the benefit that.
[AGENT][NEUTRAL] Uh, data service had been maxed out.
[CUSTOMER][NEUTRAL] OK. So, it's a limited plan?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So the remaining balance will be the patient responsibility?
[AGENT][NEGATIVE] I can't give patient responsibility.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, may I know maximum allowed amount?
[AGENT][NEUTRAL] And this is just to verify benefits. It's not a guarantee of payment. Uh, they get $1000.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it had been maxed out for the year.
[CUSTOMER][NEUTRAL] So the max benefit has been reached.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So it seems like uh
[CUSTOMER][NEGATIVE] You won't pay for this, right?
[AGENT][NEUTRAL] Uh, because the benefit.
[AGENT][NEUTRAL] Has been maxed for the year.
[CUSTOMER][NEUTRAL] OK. Thank you for that information. May I have the call reference for this number?
[AGENT][NEUTRAL] Yes, you can use my name, [PII], and today's date.
[CUSTOMER][POSITIVE] Thank you, [PII]. Thank you for that information and thank you for your assistance. Have a great day. Bye for now.
[AGENT][POSITIVE] You have a wonderful day too, Ms. [PII]. Is that all I can help you with before we go?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm. That's it.
[AGENT][POSITIVE] All right, well, you have a wonderful day and thanks for calling APL.
[CUSTOMER][POSITIVE] You too. Take care, bye.
[AGENT][NEUTRAL] Bye