AccountId: 011433970860
ContactId: 631731a0-a480-4a64-a44f-4e6d5d9779a2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 253059 ms
Total Talk Time (AGENT): 108244 ms
Total Talk Time (CUSTOMER): 54382 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/631731a0-a480-4a64-a44f-4e6d5d9779a2_20250113T19:50_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh yes, my name's [PII]. I need help with a claim please.
[AGENT][NEUTRAL] OK, uh, can I get a good callback number for you [PII]?
[CUSTOMER][NEUTRAL] Yeah, that's [PII] and that's direct.
[AGENT][NEUTRAL] OK, and are you calling from a provider's office?
[CUSTOMER][NEUTRAL] Uh, yes, hospital.
[AGENT][NEUTRAL] OK, OK, what hospital are you calling with?
[CUSTOMER][NEUTRAL] It is Prisma Health, uh, Hillcrest.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, what is the policy number for the patient we need to look at?
[CUSTOMER][NEUTRAL] Yes, I have D for delta 43728858.
[AGENT][NEUTRAL] OK, that is not one of APL's policy numbers. Do you happen to have their card or even a social where I can look them up?
[CUSTOMER][NEUTRAL] Uh, I have the social of [PII].
[AGENT][NEUTRAL] OK, give me just one second, let me.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Get them looked up real quick.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, let's see here.
[AGENT][NEUTRAL] OK, can you verify your patient's name and date of birth for me?
[CUSTOMER][NEUTRAL] [PII], date of birth is [PII].
[AGENT][NEUTRAL] Perfect. OK, um, do you have a claim number or do we just have a data service?
[CUSTOMER][NEUTRAL] I just have data service.
[AGENT][NEUTRAL] OK, that's fine. What's that data service?
[CUSTOMER][NEUTRAL] [PII], 2024.
[AGENT][NEUTRAL] And what's that total charge?
[CUSTOMER][NEUTRAL] $4,994.
[AGENT][POSITIVE] Perfect. OK, let's see here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like I do have that claim on file. It is claim number 354-0427.
[AGENT][NEUTRAL] Um, let's see when we got this.
[AGENT][NEUTRAL] Oops.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] We received it on [PII] and we processed it on [PII].
[AGENT][NEGATIVE] It looks like it was denied. Let me look up that denial for you.
[AGENT][NEUTRAL] OK, um, so the denial states that the outpatient router only allows pay payment for surgery in an outpatient setting, um, so they don't have like ER or anything like that available on their policy, so it was denied as a non-covered service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] That would have been mailed out sometime mid December right yeah we haven't gotten it yet. That's all right if I could get a call reference number.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Sure, it's just gonna be my name, so that's [PII], last initial [PII] with today's date.
[AGENT][NEUTRAL] Is there anything else I can do for you, [PII]?
[CUSTOMER][POSITIVE] Alright perfect we'll look for that that's all for today thank you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, you're welcome. Have a great day and thanks for calling APO.
[CUSTOMER][NEUTRAL] Uh huh bye bye.
[AGENT][NEUTRAL] Alright bye bye.