AccountId: 011433970860
ContactId: 5eabe34c-006f-45df-84e2-397bf5cfa119
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 260700 ms
Total Talk Time (AGENT): 73272 ms
Total Talk Time (CUSTOMER): 104183 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/5eabe34c-006f-45df-84e2-397bf5cfa119_20250213T15:07_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning. Hi, my name is [PII] calling from the Saint Mary's Hospital to check on a claim status.
[AGENT][NEUTRAL] OK [PII], you have one claim to check claim status on, is that correct?
[CUSTOMER][POSITIVE] Yes, you're right.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] My callback number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, and [PII], what is the member's policy number?
[CUSTOMER][NEUTRAL] The member's ID number I have.
[CUSTOMER][NEUTRAL] 01734133 M as in Mike [PII].
[AGENT][POSITIVE] Thank you, one moment please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And any, any information that I did provide for you today will be a verification of benefits and not a guarantee of payment.
[AGENT][NEUTRAL] What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, uh, the patient's name I have [PII], and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Yeah, that's good.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for him, please?
[CUSTOMER][NEUTRAL] Yes, uh, the date of service I have [PII] and the bill amount $1,691 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] You're welcome, and I have a specific question on the claim.
[AGENT][NEUTRAL] What is the claim number?
[CUSTOMER][NEUTRAL] I have the claim number 352-278-8.
[AGENT][NEUTRAL] One moment please.
[CUSTOMER][POSITIVE] Sure, take your time.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK. And how can I help you with that claim number?
[CUSTOMER][NEUTRAL] OK, as for checking on this claim, uh, I can see it was a denial, and the denial reason I have denied as outpatient benefit maxed out. The allowed is $1000 even and just I want to know whether it is a patient plan or providers plan.
[AGENT][NEUTRAL] For the patient's plan.
[CUSTOMER][NEUTRAL] So can we bill it to the patient, the balance which got denied?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] We do not determine patient responsibility, that would be up to the provider.
[CUSTOMER][NEUTRAL] OK, and just to confirm, it is under patient's plan, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] Thank you so much for confirmation. Uh, can you please help me with the call reference number for this claim?
[AGENT][NEUTRAL] Yes, it would be my name that I gave you along with today's date, [PII], and if you need a copy of this explanation of benefits, excuse me, you can print that from our portal by going to [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much for that, and can you please help me with your name?
[AGENT][NEUTRAL] Again, my name is [PII]
[CUSTOMER][POSITIVE] Thank you so much for all those information. It was nice talking to you and have a great day. Bye for now.
[AGENT][NEUTRAL] You're very
[AGENT][POSITIVE] It was nice talking to you as well and thank you again, [PII] for calling APL. Have a wonderful day.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye bye.