AccountId: 011433970860
ContactId: 7fdd4098-f53f-451e-87bf-f965fb934ce1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 279769 ms
Total Talk Time (AGENT): 102682 ms
Total Talk Time (CUSTOMER): 93499 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/7fdd4098-f53f-451e-87bf-f965fb934ce1_20250408T16:44_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] So, I need to verify the claim has been received or not.
[AGENT][NEUTRAL] OK, we're just needing to check on a claim. Uh, what was your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, [PII], are is this for your individual policy or are you with a provider?
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK, and can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Thank you. Do you have that policy number?
[CUSTOMER][NEUTRAL] It is 02460377 M as in Mary, L as in Lima, 8.
[AGENT][NEUTRAL] OK and then uh what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] [PII], um, it's [PII], um [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that. uh, what was the date of service for this claim, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and do you have that bill amount?
[CUSTOMER][NEUTRAL] $13,661.79.
[AGENT][POSITIVE] OK, thank you one moment please.
[AGENT][NEUTRAL] OK, and was this with, uh, is it the Christ Hospital?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So we did receive this claim we were unable to pay a benefit as their outpatient benefit for the calendar year had been met.
[CUSTOMER][NEUTRAL] Uh, one second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And then.
[CUSTOMER][NEUTRAL] But the year has been next.
[AGENT][NEUTRAL] If you'd like, I can send you a copy of this EOB.
[CUSTOMER][NEUTRAL] Um, sorry, give me one.
[CUSTOMER][NEUTRAL] Uh, yes, I do, but can I get the claim number on there cause the current claim num remit that I, the EOB that I have is denied the duplicate.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes, we did receive a duplicate um but I do have that original claim. Let me know when you're ready for that number.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] OK, that is 3550.
[AGENT][NEUTRAL] 345.
[CUSTOMER][NEUTRAL] All right. And um would that mean that the balance from uh primary is patient responsibility as the benefits are max?
[AGENT][NEUTRAL] So we don't say what is patient responsibility, that would be up to the provider.
[CUSTOMER][NEUTRAL] Oh, that's weird. Um.
[CUSTOMER][NEUTRAL] All right. Can you just send me that and then I'll figure something out.
[AGENT][NEUTRAL] Sure, of course. What was that fax number for you?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, I'm going to read that back to make sure I heard that correctly. That was [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yup, that's right.
[AGENT][POSITIVE] Alrighty, I will go ahead and get that sent to you. I should get it here within about 10 minutes or so. Was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] OK. Um, is it?
[CUSTOMER][NEUTRAL] Yeah, one second. Is there anything else on that claim that, uh, that I need to know?
[AGENT][NEGATIVE] No, that's, that's all the information that we have, yeah, but we were just unable to pay that benefit as the benefit amount had been exhausted.
[CUSTOMER][NEUTRAL] On the remit.
[CUSTOMER][POSITIVE] OK. All right. Thank you.
[AGENT][POSITIVE] Of course, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too. Bye-bye. Oh, sorry, um, reference number, please?
[AGENT][NEUTRAL] Oh sure, that would just be my first name, last initial, and today's date. Uh so my name is spelled [PII]
[CUSTOMER][POSITIVE] All right, thank you for your help.
[AGENT][POSITIVE] Of course thank you have a great day.
[CUSTOMER][NEUTRAL] Mhm.