AccountId: 011433970860
ContactId: 62c07683-3209-4063-9cac-a99e0d770cd8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 317040 ms
Total Talk Time (AGENT): 111064 ms
Total Talk Time (CUSTOMER): 131717 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/62c07683-3209-4063-9cac-a99e0d770cd8_20250227T19:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, uh, [PII]. My name is [PII] calling from Saint Vincent Evansville Hospital. And I'm checking on the claim status, medical claim status.
[AGENT][NEUTRAL] Sure, I can check a client for you. You said your name was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Got it. Thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yes. Um 02582702.
[AGENT][NEUTRAL] All right. And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Patient's first name is
[CUSTOMER][NEUTRAL] [PII] and last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you for verifying that and uh uh what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Um, [PII] and the bill amount is $7,747.39.
[AGENT][POSITIVE] Got it. Thank you. One moment, please.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, let's see, so we did receive this claim, uh, we were unable to pay a benefit as their maximum benefit payable was met for the state of service.
[CUSTOMER][NEUTRAL] Mm OK. I would like to have the uh claim details, claim number, receive date, process date, and, uh, yeah.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Of course. OK, so that claim number is 3562115.
[AGENT][NEUTRAL] And then this claim was received [PII].
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] And it was processed [PII].
[CUSTOMER][POSITIVE] 11. Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, so, fully denied as max benefit, um, rich.
[AGENT][NEUTRAL] Yes, for the date of service, um, their maximum um benefit for each date of service is $75 which looks like it had been met on a prior claim, uh, on the same date.
[CUSTOMER][NEUTRAL] On the same day. Um, let me check. Uh, is it for the same facility or different facility?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, it is for a different provider.
[CUSTOMER][NEUTRAL] And you have that?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, I would like to request an UV, um, since this is, um, uh, uh, and, uh, before that, I would like to, uh, verify if we can bill the general amount, um, to patient.
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] We don't say what is patient responsibility, that would be up to the provider.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And then I can take that fax number whenever you're ready.
[CUSTOMER][NEUTRAL] And uh there, is there any discount at night?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Let me pull up the fax number, the correct one.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, here we go.
[CUSTOMER][POSITIVE] Thank you so much for waiting. Uh, I'm ready for the fax number. Um,
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 248
[CUSTOMER][NEUTRAL] 8091708 and you can mark attention to other AA.
[AGENT][NEUTRAL] OK, I'm gonna read that number back, make sure I heard that correctly. That was [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, I will get that sent to you. You should get it here in maybe 10-15 minutes depending on how busy your machine is. Was there anything else I could help you with at all?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, yeah, I would like to, um,
[CUSTOMER][NEUTRAL] Uh, verify if there is any discount applied on this claim.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Thank you. Uh, do you have any reference number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That would just be my first name, last initial, and today's date. Um so my name is spelled [PII]
[CUSTOMER][POSITIVE] Um, [PII], right? All right. Thank you.
[AGENT][NEUTRAL] Yes, [PII] and then uh today's date.
[CUSTOMER][POSITIVE] All right. Gotcha. Uh, thank you so much, [PII], for the inform uh [PII] for the information. Have a good day.
[AGENT][NEUTRAL] Of course.
[AGENT][POSITIVE] Yeah, thanks for calling APL you too bye bye.