AccountId: 011433970860
ContactId: 7c165eec-c61e-44d0-8ecf-b4162363128b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 641109 ms
Total Talk Time (AGENT): 142249 ms
Total Talk Time (CUSTOMER): 124988 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=-0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/7c165eec-c61e-44d0-8ecf-b4162363128b_20250130T20:10_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL.
[CUSTOMER][NEUTRAL] Hi. Hi, so, I'm sorry, I had you on mute and I didn't know it.
[AGENT][NEUTRAL] Hey.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I need some help with a claim, please.
[AGENT][NEUTRAL] OK, sure. I can assist you with claims. May I have your name?
[CUSTOMER][NEUTRAL] Yes, it's [PII]
[AGENT][NEUTRAL] OK, and may I have a callback number just in case we get disconnected, Ms. [PII]?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] It's a direct line.
[AGENT][NEUTRAL] OK, and you're calling from a provider's office?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what's the name of the facility or the provider?
[CUSTOMER][NEUTRAL] It's gonna be Baptist Medical Center.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Policy number [PII].
[AGENT][NEUTRAL] OK, bear with me.
[AGENT][NEUTRAL] Mm, can you repeat that number? It seems to have too many numbers.
[CUSTOMER][NEUTRAL] Yep, it's 2, let me make sure I got it right, hold on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hold on, so right. Hold on, sorry, I was on the wrong patient. I'm sorry, 01851923.
[AGENT][NEUTRAL] Yeah, it's OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 923, yeah, that sounds more like us. OK, one moment.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Any other last names?
[CUSTOMER][NEUTRAL] Mm, let's see, hold on.
[CUSTOMER][NEUTRAL] We've got it as [PII]. Let me check and see if we have a copy of her ID and see if her ID says something different.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Her primary insurance her has her as [PII] too, um.
[CUSTOMER][NEUTRAL] See.
[CUSTOMER][NEUTRAL] Scans for insurance card.
[CUSTOMER][NEUTRAL] I'm looking, hold on, that's the other insurance card.
[AGENT][POSITIVE] OK, sure, yeah, take your time.
[CUSTOMER][NEUTRAL] They have the insured is [PII], so.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm wondering if like her last name has changed or something. I'm looking now.
[AGENT][NEUTRAL] Mhm, mhm.
[CUSTOMER][NEUTRAL] Because we don't have a copy of her ID.
[AGENT][POSITIVE] Got you. Yeah.
[CUSTOMER][NEUTRAL] Oh hold on, I mean I just found it hold on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's see, yeah, her driver's license is [PII].
[AGENT][NEUTRAL] OK. All right. Well, um, it looks like uh on this policy, she's gonna be under the main holder's last name. Um, she's independent. OK, so, uh, let's see. And you say you need a claim status, and what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Data service is $724.24 total bill amount is $3,351.35.
[AGENT][NEUTRAL] OK. All right, let me see if I can find that claim.
[AGENT][NEUTRAL] OK, here it is, um, let me pull the EOB one moment.
[AGENT][NEUTRAL] It's gonna be one more minute. I'm waiting on the EOB to upload.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK. Mhm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so, um, we processed the claim [PII] and the claim was denied. The reason for this denial is that the policy does not provide benefits for uh pregnancy of a dependent child.
[CUSTOMER][NEUTRAL] Can I do to does not.
[CUSTOMER][POSITIVE] Have benefits for pregnancy.
[CUSTOMER][NEUTRAL] Um, dependent.
[CUSTOMER][NEUTRAL] Can you give me the claim number that was assigned to it?
[AGENT][NEUTRAL] Mhm. Yes. Claim number is 3518291.
[CUSTOMER][NEUTRAL] And when was it denied?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Is there any way you can fax me a copy of that denial EOB?
[AGENT][NEUTRAL] Yeah, mhm. What is the fax number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. [PII] to your attention.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, do you mind holding for me while I send this out to you right now?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me, Ms. [PII]. Yeah, I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No ma'am, what was your name? and I need a reference number.
[AGENT][NEUTRAL] My name is [PII]. That's [PII], last initial [PII], and we don't have reference numbers. You can use my name in today's date.
[CUSTOMER][POSITIVE] All right well thank you so much I hope you have a wonderful day.
[AGENT][NEUTRAL] USL necessity and thank you for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Alright bye bye.