AccountId: 011433970860
ContactId: 597fdde2-3983-4441-baa8-04579d040fad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 345260 ms
Total Talk Time (AGENT): 160692 ms
Total Talk Time (CUSTOMER): 136420 ms
Interruptions: 4
Overall Sentiment: AGENT=0.8, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/597fdde2-3983-4441-baa8-04579d040fad_20250214T20:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. Excuse me, my name is [PII]. I'm with Baptist Health Medical Group, and I was calling to see about getting assistance on two claims for members.
[AGENT][NEUTRAL] Sure, I can check those claims for you. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you and then do you have the policy number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I have what I hope is your policy number.
[CUSTOMER][NEUTRAL] Um, I have 01823445 M as in Mary, L as in Larry 8.
[AGENT][NEUTRAL] Thank you and then what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII] and I know you said we had a couple of claims. Are they both for the same member?
[CUSTOMER][NEGATIVE] No, they're not.
[AGENT][NEUTRAL] OK, OK, let's see what was the date of service for this one?
[CUSTOMER][NEUTRAL] 323 of 24.
[AGENT][NEUTRAL] OK, so I will tell you, [PII], that she, I just checked, um, the last policy that she had with us terminated [PII], um, so I can still see if we received the claim if you'd like, um, that's completely up to you.
[CUSTOMER][NEUTRAL] Yeah, no, it's OK if that termed we're fine.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, uh let's see.
[AGENT][NEUTRAL] What was that other policy number?
[CUSTOMER][NEGATIVE] Let me pull that up real quick. OK, the next, oh my gosh, it doesn't even, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I have 1067765.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for this number?
[CUSTOMER][NEUTRAL] It's [PII] [PII].
[AGENT][NEUTRAL] OK thank you um and what was the date of service for this one?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so this one was active during that time, um, what was that bill amount?
[CUSTOMER][NEUTRAL] Uh, that's $1,079.
[AGENT][NEUTRAL] OK thank you one moment please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So we did receive this claim, [PII], uh, we were unable to pay a benefit as the maximum amount payable for this occurrence had met, uh, so that their outpatient benefit is on a per occurrence basis and so this one had been exhausted.
[CUSTOMER][NEUTRAL] OK, let me ask this because we have not received a remit.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Can I get it faxed or emailed? Yeah, OK.
[AGENT][NEUTRAL] I can send you that.
[AGENT][POSITIVE] Of course, absolutely. What was that fax number for you?
[CUSTOMER][NEUTRAL] It's [PII] and just make that attention [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I'm gonna read that number back to you to make sure I heard that correctly, uh, that was [PII].
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK, alrighty, I will go ahead and get that sent now. Uh, you should get it here in maybe 10-15 minutes depending on uh how busy your machine is. Did you need that claim number?
[CUSTOMER][POSITIVE] Uh, yes, that'll be helpful, thank you.
[AGENT][NEUTRAL] OK, sure, that is 3549877.
[CUSTOMER][NEUTRAL] And let me ask this, um, just because.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I try to be. Do you have a provider web portal?
[AGENT][NEUTRAL] So we do 44 claims yes it is specifically 4 claims um from what I understand it's you would have to have that claim number to check the claims though so like if you would need um clarification regarding an EOB.
[CUSTOMER][NEUTRAL] That I can check claims.
[CUSTOMER][NEUTRAL] Oh, so if I was just looking for a claim status without a claim number, then I wouldn't be able to pull it up.
[AGENT][POSITIVE] Yeah, that's right, right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and so if I'm working a project and I've got multiples to check, um, is there any way to, I don't know, email that information to, to have it checked or I'm just other than being, you know, tying up the phone all day trying to think of uh a better way.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, I see what you're saying so like if you had a lot of claims to check, you mean?
[CUSTOMER][NEUTRAL] Right. Mhm.
[AGENT][POSITIVE] No, yeah, you would just give us a call, um, but that's perfectly fine that is what we do so that's completely fine, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I get it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, well, um, I, I think, uh, if I could get, I'm sorry I did not write down your name at the beginning of the call and then a call reference.
[AGENT][NEUTRAL] Alrighty, did you have any other questions for me?
[AGENT][NEUTRAL] Oh, that's OK.
[AGENT][NEUTRAL] Sure, so the reference number would just be my first name, last initial, and today's date, um, so my name is spelled [PII], last [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's is it [PII]?
[AGENT][NEUTRAL] Oh, [PII], yeah.
[CUSTOMER][POSITIVE] Thank you. OK
[AGENT][NEUTRAL] Of course.
[CUSTOMER][POSITIVE] Alright, well, thank you so much. I appreciate it. You have a rest, a good rest of your day.
[AGENT][POSITIVE] Yeah, you're very welcome.
[AGENT][POSITIVE] You too thanks bye bye.
[CUSTOMER][POSITIVE] Thanks. Bye.