AccountId: 011433970860
ContactId: 8628bfd4-9540-47d8-b3f2-18abb5e6a928
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 305920 ms
Total Talk Time (AGENT): 107024 ms
Total Talk Time (CUSTOMER): 59500 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/8628bfd4-9540-47d8-b3f2-18abb5e6a928_20250624T15:00_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, yes, I'm calling to get.
[CUSTOMER][NEUTRAL] I guess last time they transferred me to the payment department I'm not sure but I'm calling the status of the claim.
[AGENT][NEUTRAL] Need to check on a claim.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I can help with the claim. Do you have the patient's policy number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] D 43728531
[AGENT][NEUTRAL] OK. I unfortunately can't pull them with that number. Do you have their card? Do you have like a certificate number by chance? If not, I can look by name or social.
[CUSTOMER][NEUTRAL] Let me give you their social. Let me just pull it up. Give me a second. It's a little bit for it to come up.
[AGENT][NEUTRAL] Nope.
[AGENT][POSITIVE] Yeah, no problem.
[CUSTOMER][NEUTRAL] Um, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] What is the patient's first and last name, please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And then what is the data service?
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] In the amount of $3,677 and can I get your name again? I'm sorry.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, no problem. My name is [PII]. That's [PII]
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] OK, so it looks like we did get a claim for the state of service on [PII]. The claim was processed and denied [PII]. It looks like the maximum benefit for the outpatient had been exhausted already.
[CUSTOMER][NEUTRAL] What do you have a claim number?
[AGENT][NEUTRAL] Claim number is 3566662.
[CUSTOMER][NEUTRAL] Is it so that the balance of PCR?
[AGENT][NEUTRAL] So yeah we don't advise on patient responsibility it's up to the facility or provider as far as what you know if they wanna build the patient.
[CUSTOMER][NEUTRAL] Um, but I'm seeing on the ELB it doesn't say.
[AGENT][NEUTRAL] No, it does not state. Mm mm.
[AGENT][NEUTRAL] I can send you a copy of the EOB if you'd like.
[CUSTOMER][NEUTRAL] Please, I can give you the fax number.
[AGENT][POSITIVE] Absolutely. What's the good fax number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Should I mark attention to anybody on that?
[CUSTOMER][NEUTRAL] And it comes directly to me.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] So there there is no patient responsibility on it.
[AGENT][NEGATIVE] Yeah, that's not gonna advise on that. Um, it's just gonna show the denial and the reason why on it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Was there anything else that I can check on for you?
[CUSTOMER][NEUTRAL] No, ma'am.
[AGENT][POSITIVE] Alright, [PII] is on his way. Thanks for calling APL. I hope you have a nice rest of your day.
[CUSTOMER][NEUTRAL] Is there a call reference number or just your name?
[AGENT][NEUTRAL] Uh, yeah, absolutely. You can use my name with my last initial and today's date. My name again is [PII], initial to my last name is [PII], and then today's date.
[CUSTOMER][POSITIVE] OK thank you have a good day.
[AGENT][NEUTRAL] You too bye bye.