AccountId: 011433970860
ContactId: 701be8d4-8b15-44de-a71e-a452c4717018
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 234619 ms
Total Talk Time (AGENT): 90120 ms
Total Talk Time (CUSTOMER): 56027 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/701be8d4-8b15-44de-a71e-a452c4717018_20250401T14:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ACL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], my name is [PII]. Um, I am with Georgetown Memorial Hospital, and I was calling to check on the status of a claim to see what additional information is needed to process.
[AGENT][NEUTRAL] OK. I'm happy to check out the claim today, [PII]. What is the patient's policy number?
[CUSTOMER][NEUTRAL] 02560355.
[AGENT][NEUTRAL] Alright, OK.
[AGENT][NEUTRAL] And then patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] This is for [PII], [PII].
[AGENT][POSITIVE] Thank you. The data service.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Day of service [PII].
[AGENT][NEUTRAL] And then the middle of them
[CUSTOMER][NEUTRAL] $3,267.
[AGENT][NEUTRAL] OK, so I'm showing [PII], that we did get the claim. It looks like it was denied. Um, it's showing the outpatient benefit for the calendar year has been met, so it looks like there's nothing additional pay.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] So that makes a patient responsibility.
[AGENT][NEUTRAL] Yeah, I don't show any. I don't think we don't need any additional info from what I show.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, um, uh, that's fine. I'll get in contact with the patient. Can I have a call reference number, please?
[AGENT][NEUTRAL] Absolutely. Call references my name with my last initials in today's date. My name is [PII], that's [PII] Last initials of my name is [PII], and then today's date.
[CUSTOMER][NEUTRAL] Do you know when the um when that benefit was the outpatient benefit was met?
[AGENT][NEUTRAL] Um, let me see if I can find it. Give me just.
[AGENT][NEUTRAL] So it looks like um this claim was processed on [PII].
[AGENT][NEUTRAL] There was a claim previously before that process on [PII]. It looks like that's the one that maxed out the benefits. The date of service was after it was [PII]. This claim is just submitted prior to the other one.
[CUSTOMER][NEUTRAL] So it's based on a yearly benefit.
[AGENT][NEGATIVE] Yeah, yeah, so the yearly max was already exhausted.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh, OK. OK. All right. No problem. Thank you for your, um, oh, thank you for your help. I hope you have a great day, [PII].
[AGENT][POSITIVE] You too, [PII]. Take care.
[CUSTOMER][POSITIVE] You're welcome bye bye.