AccountId: 011433970860
ContactId: 706d6eb0-ca05-44b8-ba5e-03ace188820e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 175919 ms
Total Talk Time (AGENT): 80218 ms
Total Talk Time (CUSTOMER): 71440 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/706d6eb0-ca05-44b8-ba5e-03ace188820e_20250305T16:47_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Uh, my name is [PII], last name initial [PII], and I'm calling from Memorial Hospital to check the status on a patient.
[AGENT][NEUTRAL] Uh, eligibility?
[CUSTOMER][NEUTRAL] Claim status.
[AGENT][NEUTRAL] Client status got you sorry about that. um, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] It's [PII] and it's direct.
[AGENT][NEUTRAL] Got it, thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] Uh yes, the policy number is 019299.
[CUSTOMER][NEUTRAL] 27 ML 7.
[AGENT][NEUTRAL] OK and then uh what was the name and date of birth for the insured please?
[CUSTOMER][NEUTRAL] It's [PII], and her date of birth is [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that [PII] and uh what was the date of service for this claim?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII] and then do you have that bill amount?
[CUSTOMER][NEUTRAL] It is $703.55.
[AGENT][NEUTRAL] $703.53.
[CUSTOMER][NEUTRAL] And 55 cents.
[AGENT][NEUTRAL] 55, sorry about that OK.
[CUSTOMER][NEUTRAL] It's OK.
[AGENT][NEUTRAL] All right. One moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I will let you know uh that this policy terminated [PII]. I did check to see if she had one that was active at that time and this was the last policy she had with us. Um, did you still want me to see if we received the claim?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] No, you received the claim. I have a claim number, but the denial is telling me it's telling me we have received the primary explanation of benefit that was submitted with your claim. However, the explanation of benefit received does not, uh, list the amount applied to the deductible, co-pay, or, or co-insurance. Please submit a more detailed explanation of benefits that shows these amounts for further consideration. Why would they say this if the policy is not active? It makes no sense.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Oh.
[AGENT][NEGATIVE] Let me look, yeah, I'm not sure you're right.
[AGENT][NEUTRAL] Oh my gosh, I'm sorry about that. That is, but yes, um, it's the um terminated as of, uh, [PII].
[CUSTOMER][NEUTRAL] It's crazy.
[CUSTOMER][NEUTRAL] OK, can I get it from reference number?
[AGENT][NEUTRAL] Sorry about the confusion. Sure, um, that would just be my first name, last initial, and today's date. Uh so my name is spelled [PII] Was there anything else I could help you with?
[CUSTOMER][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That's it thank you so very much you have a great day I appreciate it.
[AGENT][POSITIVE] Of course, thanks for calling APL you too bye bye.
[CUSTOMER][POSITIVE] Take care bye bye.