AccountId: 011433970860
ContactId: 73c884fb-5f1f-4507-92d2-d17eb9ca007d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1342390 ms
Total Talk Time (AGENT): 215068 ms
Total Talk Time (CUSTOMER): 496879 ms
Interruptions: 3
Overall Sentiment: AGENT=1.2, CUSTOMER=1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/73c884fb-5f1f-4507-92d2-d17eb9ca007d_20250206T16:46_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] with patient accounts.
[CUSTOMER][NEUTRAL] With Kettering Health main campus and I just need to check status on a claim please.
[AGENT][POSITIVE] Well, [PII], it would be my pleasure to assist you with that claim status today. What is a good callback number?
[CUSTOMER][NEUTRAL] It's [PII] my [PII] [PII].
[AGENT][NEUTRAL] Thank you, [PII], and what is the policy number for the patient please ma'am?
[CUSTOMER][NEUTRAL] Um, I hope this is the same one. It starts with the letter D as in David, 45401458.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you
[AGENT][NEUTRAL] Yeah, that's not our policy number, [PII]. Let me do a name, sir. Do you have the one that starts with a 0?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Let me see, just a second. This is, this was actually was sent to uh.
[CUSTOMER][NEUTRAL] What did we, oh, benefits and a card and they denied it and they said they forwarded it on to your all's office, so I'm not for sure. Let me see if I have something on it if I have another card.
[AGENT][NEUTRAL] OK. All right.
[AGENT][NEUTRAL] If not, we can do it by name.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's see card.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] This
[AGENT][POSITIVE] That made me happy.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] That the music you all have on your whole music, I was still, it still was in my head.
[AGENT][POSITIVE] I like that song too.
[CUSTOMER][NEUTRAL] OK, I don't have any other ID number except this one I gave you. It started with the [PII]
[AGENT][NEUTRAL] Well, let's do a name search. What is the patient's last name?
[CUSTOMER][NEUTRAL] So I don't
[CUSTOMER][NEUTRAL] It's [PII], I guess I say it. It's [PII]
[AGENT][NEUTRAL] And the first name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] What is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] She did have a medical policy with us. It's no longer active, but she did have one. What was that date of service?
[CUSTOMER][POSITIVE] Mhm thank you.
[CUSTOMER][NEUTRAL] Uh, this one was [PII].
[AGENT][NEUTRAL] And that bill amount?
[CUSTOMER][NEUTRAL] $13,519.
[AGENT][NEUTRAL] And what was the facility name?
[CUSTOMER][NEUTRAL] It's Kettering Health Main Campus.
[AGENT][NEUTRAL] So we don't have that claim on file. Now her policy was active for that data service. I can give you her policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] It is 248.
[AGENT][NEUTRAL] 4211.
[AGENT][NEUTRAL] Are you a multi-plan provider?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so it would need to go back and they said they forwarded the claim to us?
[CUSTOMER][NEUTRAL] Uh-huh, back on [PII].
[AGENT][NEUTRAL] Yeah, I don't have it on file.
[CUSTOMER][NEUTRAL] I guess she has like a, I guess.
[CUSTOMER][NEUTRAL] I don't know what I'm don't, I don't know the word I'm trying to look for, but they like I said, they, they had denied it saying that she had wellness, uh, coverage only and I guess she had this additional policy or.
[AGENT][NEUTRAL] Right. We're medical.
[CUSTOMER][NEUTRAL] Or something.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. Uh, can, uh,
[AGENT][NEUTRAL] That's a facility claim, right?
[CUSTOMER][NEUTRAL] Do you all accept facts?
[CUSTOMER][NEUTRAL] Right, right. It was an emergency room visit.
[AGENT][NEUTRAL] And did they send you the repricing information through multi plan?
[AGENT][NEUTRAL] For multi-plan.
[CUSTOMER][NEGATIVE] She did not, no.
[AGENT][NEUTRAL] So if you're a multi-plan provider, it does need to go back to the uh [PII] in [PII] because they send it to be repriced through multi-plan.
[AGENT][NEUTRAL] Now with our processing there's no contractual involvement we just process for benefits, but if you want to send them a claim and then send a claim, you can fax a claim to us for benefit processing, but there would be no, uh, amount repricing repricing through us.
[CUSTOMER][NEUTRAL] OK, OK, alright, so I'll just give them a call back and see if they can uh forward it again back to you all.
[AGENT][NEUTRAL] Yeah, you know what? Hang on just a second. Let me see if I can get them on the line, OK? And this was for a facility claim, right?
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][POSITIVE] Alright, thank
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Hold on just a minute if you don't mind.
[AGENT][NEUTRAL] OK, [PII], let me get them on the line and see if they have it and that way you don't have to worry about it, but if you'll hang just one moment, please.
[CUSTOMER][POSITIVE] All right, thank you. Uh-huh.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Thank you for calling 90 Degree Benefits, the administrator for benefits in a card members. Please select from the following options to ensure you are directed to the appropriate party to answer all agents are currently assisting other callers.
[CUSTOMER][NEUTRAL] Please remain on the line and your call will be answered by the next agent.
[CUSTOMER][POSITIVE] We appreciate your call.
[CUSTOMER][POSITIVE] We appreciate your patience. Please remain on the line, and we will be with you shortly.
[CUSTOMER][POSITIVE] We apologize for the longer than expected wait time.
[CUSTOMER][NEUTRAL] Your call is important to us.
[CUSTOMER][NEUTRAL] If you prefer, you can leave a detailed voicemail message, and we will get back to you promptly. Press 1 to leave a voicemail.
[CUSTOMER][POSITIVE] We apologize for the longer than expected wait time.
[CUSTOMER][NEUTRAL] Your call is important to us.
[CUSTOMER][NEUTRAL] If you prefer, you can leave a detailed voicemail message, and we will get back to you promptly. Press 1 to leave a voicemail.
[CUSTOMER][POSITIVE] We apologize for the longer than expected wait time.
[CUSTOMER][NEUTRAL] Your call is important to us.
[CUSTOMER][NEUTRAL] If you prefer, you can leave a detailed voicemail message, and we will get back to you promptly. Press 1 to leave a voicemail.
[CUSTOMER][POSITIVE] We apologize for the longer than expected wait time.
[CUSTOMER][NEUTRAL] Your call is important to us.
[AGENT][NEUTRAL] [PII], I'm still on hold. Do you mind holding just another moment?
[CUSTOMER][POSITIVE] Don't mind at all, thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] We apologize for the longer than expected wait time.
[CUSTOMER][NEUTRAL] Your call is important to us.
[CUSTOMER][NEUTRAL] If you prefer, you can leave a detailed voicemail message, and we will get back to you promptly. Press 1 to leave a voicemail.
[CUSTOMER][POSITIVE] We appreciate your patience. Please remain on the line, and we will be with you shortly.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] One
[AGENT][NEUTRAL] So
[CUSTOMER][POSITIVE] We apologize for the longer than expected wait time.
[CUSTOMER][NEUTRAL] Your call is important to us.
[CUSTOMER][NEUTRAL] If you prefer, you can leave a detailed voicemail message, and we will get back to you promptly. Press 1 to leave a voicemail.
[CUSTOMER][POSITIVE] We apologize for the longer than expected wait time.
[CUSTOMER][NEUTRAL] Your call is important to us.
[CUSTOMER][NEUTRAL] If you prefer, you can leave a detailed voicemail message, and we will get back to you promptly. Press 1 to leave a voicemail.
[CUSTOMER][POSITIVE] We apologize for the longer than expected wait time.
[CUSTOMER][NEUTRAL] Your call is important to us.
[CUSTOMER][POSITIVE] If you prefer, you can leave a detailed voicemail message, and we will get back to you promptly.
[CUSTOMER][NEUTRAL] Press 1 to leave a voicemail.
[CUSTOMER][POSITIVE] We apologize for the longer than expected wait time.
[CUSTOMER][NEUTRAL] Your call is important to us.
[CUSTOMER][NEUTRAL] If you prefer, you can leave a detailed voicemail message, and we will get back to you promptly. Press 1 to leave a voicemail.
[CUSTOMER][POSITIVE] We apologize for the longer than expected wait time.
[CUSTOMER][NEUTRAL] Your call is important to us.
[CUSTOMER][NEUTRAL] If you prefer, you can leave a detailed voicemail message, and we will get back to you promptly. Press 1 to leave a voicemail.
[CUSTOMER][POSITIVE] We appreciate your patience. Please remain on the line, and we will be with you shortly.
[CUSTOMER][POSITIVE] We apologize for the longer than expected wait time.
[CUSTOMER][NEUTRAL] Your call is important to us.
[CUSTOMER][NEUTRAL] If you prefer, you can leave a detailed voicemail message, and we will get back to you promptly. Press 1 to leave a voicemail.
[CUSTOMER][POSITIVE] We apologize for the longer than expected wait time.
[CUSTOMER][NEUTRAL] Your call is important to us.
[CUSTOMER][NEUTRAL] If you prefer, you can leave a detailed voicemail message, and we will get back to you promptly. Press 1 to leave a voicemail.
[CUSTOMER][POSITIVE] We apologize for the longer than expected wait time.
[CUSTOMER][NEUTRAL] Your call is important to us.
[CUSTOMER][NEUTRAL] If you prefer, you can leave a detailed voicemail message, and we will get back to you promptly. Press 1 to leave a voicemail.
[AGENT][NEGATIVE] [PII], they still haven't answered. I'm still on hold.
[CUSTOMER][NEUTRAL] OK, alright, do you just want me to call back later or because I don't know how long you are allowed to sit on hold also.
[AGENT][POSITIVE] No, I, I'm, I'm fine just to take care of you. That's my, that's my job is to take care of you. Are you OK with that?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, that's fine.
[AGENT][NEUTRAL] OK. All right. Hang on just a minute. Mhm.
[CUSTOMER][POSITIVE] All right, thanks. All right, thank you. Message and we will get back to you promptly. Press 1 to leave a voicemail.
[CUSTOMER][NEUTRAL] Thank you for calling 90 Degree Benefits, the administrator for benefits in a card. All agents are currently assisting other callers. Please remain on the line and your call will be answered by the next agent.
[CUSTOMER][POSITIVE] We appreciate your call.
[CUSTOMER][POSITIVE] We appreciate your patience. Please remain on the line, and we will be with you shortly.
[CUSTOMER][POSITIVE] We apologize for the longer than expected wait time.
[CUSTOMER][NEUTRAL] Your call is important to us.
[CUSTOMER][NEUTRAL] If you prefer, you can leave a detailed voicemail message, and we will get back to you promptly. Press 1 to leave a voicemail.
[CUSTOMER][POSITIVE] We apologize for the longer than expected wait time.
[CUSTOMER][NEUTRAL] Your call is important to us.
[CUSTOMER][NEUTRAL] If you prefer, you can leave a detailed voicemail message, and we will get back to you promptly. Press 1 to leave a voicemail.
[CUSTOMER][POSITIVE] We apologize for the longer than expected wait time.
[CUSTOMER][NEUTRAL] Your call is important to us.
[CUSTOMER][NEUTRAL] If you prefer, you can leave a detailed voicemail message, and we will get back to you promptly. Press 1 to leave a voicemail.
[CUSTOMER][POSITIVE] We apologize for the longer than expected wait time.
[CUSTOMER][NEUTRAL] Your call is important to us.
[CUSTOMER][NEUTRAL] If you prefer, you can leave a detailed voicemail message, and we will get back to you promptly. Press 1 to leave a voicemail.
[CUSTOMER][POSITIVE] We apologize for the longer than expected wait time.
[CUSTOMER][NEUTRAL] Your call is important to us.
[CUSTOMER][NEUTRAL] If you prefer, you can leave a detailed voicemail message, and we will get back to you promptly. Press 1 to leave a voicemail.
[CUSTOMER][POSITIVE] We appreciate your patience. Please remain on the line, and we will be with you shortly.
[CUSTOMER][NEUTRAL] 90 Degree benefits, this is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey [PII], it's [PII]. How are you doing?
[CUSTOMER][POSITIVE] Hi, I'm good. How are you?
[AGENT][POSITIVE] I'm doing good, thank you for asking. I'm sorry to say thank you for calling.
[AGENT][NEUTRAL] Lord have [PII]. I have a, uh, had a provider on the line, [PII] calling uh regarding a claim for [PII]. Does that sound familiar for me here? Boy, that sounded southern.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I feel like I just
[AGENT][NEUTRAL] Premier.
[CUSTOMER][NEUTRAL] I feel like I just talked to someone about this.
[AGENT][NEUTRAL] Yeah, um, [PII].
[CUSTOMER][NEUTRAL] What did you say her name was?
[CUSTOMER][NEUTRAL] No, the uh, the provider's name.
[AGENT][NEUTRAL] Oh, [PII].
[CUSTOMER][NEUTRAL] Oh yeah, I just talked to somebody named [PII] and sent them. OK, you can send them over. I don't know how that happened, how they got to you.
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] She just, she just hung up, so I've been on hold, so she just hung up, but I'll call her back. She was calling in reference to a claim um on [PII]'s policy that someone said it was forwarded to forwarded it to us and I don't see it.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh, OK, that was that one. OK. She, she asked me about like 6 other other claims, so, um, let's see.
[AGENT][NEUTRAL] Yeah, it was for a facility claim.
[CUSTOMER][NEUTRAL] Uh da da da da da da.
[AGENT][NEUTRAL] data service 94 for facility claim.
[CUSTOMER][NEUTRAL] 94, there it is. Yeah, it's showing we sent it over to you guys by fax on [PII].
[AGENT][NEUTRAL] I don't have it. It didn't come through. Can, can you refax that to us?
[CUSTOMER][POSITIVE] I absolutely will. Yes, ma'am.
[AGENT][POSITIVE] Perfect. And then we'll get that processed for her and I'll call [PII] back and let her know.
[CUSTOMER][POSITIVE] OK. All right. Thank you, ma'am.
[AGENT][POSITIVE] My pleasure. Hope you have a great day.
[CUSTOMER][POSITIVE] OK. Thanks, you too.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][POSITIVE] Bye-bye. You're welcome. Bye.