AccountId: 011433970860
ContactId: 6ef2b72e-adcf-47ed-bcf3-896955226da4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 565479 ms
Total Talk Time (AGENT): 131141 ms
Total Talk Time (CUSTOMER): 138304 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/6ef2b72e-adcf-47ed-bcf3-896955226da4_20250501T18:13_UTC.wav
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[AGENT][POSITIVE] Thank you for calling
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] Hello, my name is [PII]. Your name, name is spelled, please?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Can you spell your name, please?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Oh thank you so much. My name is [PII]. I have received claim. This claim is denied. Can you check the status for this?
[AGENT][POSITIVE] Yes I could check claim status for you [PII]. May I please get your callback number just in case the call gets dropped I'll be able to call you right back.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Patient name [PII], and date of birth, [PII]. Policy number 02510281.
[AGENT][NEUTRAL] OK, and then let me look that policy up real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then what is the data service and the charge amount?
[CUSTOMER][NEUTRAL] That the service [PII] and the charge amount.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] $3,196 3196 dollars even.
[AGENT][NEUTRAL] OK, thank you. And what's the name of the facility?
[CUSTOMER][NEUTRAL] Uh, Franklin Woods Community Hospital, also known as Mountain State Health Clinic.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up this claim for you, [PII], and I will be right back sir.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, [PII]. I've got the claim information for you.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] The number is 3549718.
[CUSTOMER][NEUTRAL] Your voice is break. Can you repeat again?
[AGENT][NEUTRAL] And playing
[AGENT][NEUTRAL] Yes, 354 9.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Can you hear me?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] 354971.
[CUSTOMER][NEUTRAL] Region of the region.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Yes, the claim was denied because the benefit had been maxed out for the calendar year.
[CUSTOMER][NEUTRAL] Benefits?
[AGENT][NEUTRAL] Yeah, benefit max out for the calendar year.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEGATIVE] Your voice, your voice is breaking. I'm not able to.
[AGENT][POSITIVE] Yes, the benefit has maxed out.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, ma'am, I hear you.
[CUSTOMER][POSITIVE] Just be good. Yes, the benefit has been made, right?
[AGENT][NEUTRAL] Can you hear me, [PII]?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Yeah, but if it has been met for the calendar year.
[CUSTOMER][NEUTRAL] Calendar year [PII], right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK. So benefit has been met for the calendar year [PII]. And can you confirm what type of benefit has been made?
[AGENT][NEUTRAL] Can I verify what, sir?
[CUSTOMER][NEUTRAL] You are saying benefit has been made for the calendar year [PII].
[AGENT][NEUTRAL] Can you repeat?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, hello. Can you hear me?
[CUSTOMER][NEUTRAL] I'm saying, you are saying benefits has
[AGENT][NEUTRAL] I can hear you.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, I hear you.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] I hear you, [PII].
[CUSTOMER][NEUTRAL] So, can you confirm again then I just talk to you.
[CUSTOMER][NEUTRAL] Yes, please say the again again proper.
[AGENT][POSITIVE] Yes, the benefit
[AGENT][POSITIVE] Yes, the benefit has been met for the calendar year.
[CUSTOMER][NEUTRAL] So now what we can do, this is the patient responsibility.
[AGENT][NEUTRAL] We don't give patient responsibility that's determined by the provider.
[CUSTOMER][NEUTRAL] Sorry, what did you say?
[AGENT][NEGATIVE] We do not give patient responsibility.
[CUSTOMER][NEUTRAL] So now what we can do.
[AGENT][NEUTRAL] That is up to your procedures that you do with your billing department.
[CUSTOMER][NEUTRAL] So we'll just wait with
[CUSTOMER][NEUTRAL] So you are saying benefit has been meant for the calendar year [PII].
[CUSTOMER][NEUTRAL] So, uh, OK, call this number?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, you can use my name [PII] in today's date.
[CUSTOMER][NEUTRAL] Just wait a minute.
[CUSTOMER][NEUTRAL] So I, I want to know what benefit, which uh is me, medical benefit or any other?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] The patient gets 2 visits a calendar year and those ER visits have been met for the calendar year.
[CUSTOMER][NEUTRAL] Oh, patient, how much, how much?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello, I said 2.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEGATIVE] Sorry, your voice is totally break.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] OK, let me see if I can fix it, hold on.
[AGENT][NEUTRAL] OK, the insured gets 2 visits per year and they use them up.
[CUSTOMER][NEUTRAL] Oh, I, I, I understood you're saying patient had 2 visits per year and made to visit patient had no more visits, right?
[AGENT][POSITIVE] Correct. Yes, you're right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you
[AGENT][POSITIVE] You're welcome