AccountId: 011433970860
ContactId: 89dd392e-08ca-4c60-8c2e-18253350dc8b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 442929 ms
Total Talk Time (AGENT): 135976 ms
Total Talk Time (CUSTOMER): 221267 ms
Interruptions: 6
Overall Sentiment: AGENT=1.7, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/89dd392e-08ca-4c60-8c2e-18253350dc8b_20250103T14:24_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is. How may I assist you?
[CUSTOMER][POSITIVE] Hi, so, good morning. [PII] to you. How are you?
[AGENT][POSITIVE] Thank you. Happy [PII]. I'm good, thank you. How are you?
[CUSTOMER][NEUTRAL] Good, good, good, thank you. This is [PII] from Baptist Hospital, the Miami Cancer Institute. I was trying to find out, um, I have a patient here that I'm about to bill you guys some more for some other claims, but um we have some claims that were pending for her. So I was wondering, um, see if you guys have received them cause we have more coming up.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, sure, I can assist you with that, with claims and may I have a callback number just in case we get disconnected Miss [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, 02554589.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] See that
[CUSTOMER][NEUTRAL] Yes, ma'am. So this patient is [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And um let's see, this one I just filled out. So it will be this one here. OK. Mhm. So the first day that I'm showing is for [PII].
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh, for $1,478.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Let me go back up this way.
[AGENT][NEUTRAL] OK, let me check on that one.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Nice.
[CUSTOMER][NEUTRAL] that I have [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Let me
[AGENT][NEUTRAL] Mm let me see if I got pending.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No, um
[AGENT][NEUTRAL] I don't have that claim on file.
[CUSTOMER][NEUTRAL] Oh, that one is not on file. OK, is she, what is the effective date please, so, um.
[AGENT][NEGATIVE] Mm mm mm no.
[AGENT][NEUTRAL] On this policy, the effective date is [PII].
[CUSTOMER][NEUTRAL] [PII], and they're still active, right? Still active, I think.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yeah, it's still active, yeah, mhm, but I have no claims on file for Ms. [PII]. There's no claims at all.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. What about um [PII]?
[CUSTOMER][NEUTRAL] For 1,478.
[AGENT][NEUTRAL] Mhm it's not [PII].
[CUSTOMER][NEUTRAL] [PII]. No, ma. And [PII], no claim at all? OK, OK. You did say that.
[AGENT][POSITIVE] No, we have no claims at all.
[AGENT][POSITIVE] No claims at all.
[CUSTOMER][NEUTRAL] OK, because I have 123456. OK, OK, OK. All right, um, let me go ahead and um.
[AGENT][POSITIVE] That's good.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Get them back out. I don't know what's going on here. Cause I noticed you guys always respond really quickly and I said nothing from you guys. So I just wanna make sure, you know, I just make sure that something going on, we'll have to try to get it fixed. Can I ask you on another patient since I have you on the phone?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yes, I understand.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Uh, sure, yes, let me go ahead and just make a quick note on this one, OK?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Sure. Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, that's in.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] And.
[AGENT][POSITIVE] OK, and I'm ready for the next one.
[CUSTOMER][NEUTRAL] Um, [PII], I'm sorry, you know, 01839217.
[AGENT][NEUTRAL] Alright, OK, and may I have the name and date of birth?
[CUSTOMER][NEUTRAL] Sure, thank you. [PII]. Date of birth [PII].
[AGENT][POSITIVE] Perfect. And what is the date of service for this one?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And how much is the total charge for this one?
[CUSTOMER][NEUTRAL] 5,152.
[AGENT][NEUTRAL] OK, alright, let me go for this one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me pull this um EOB.
[AGENT][NEUTRAL] I'm still waiting on the EOB to pull up, OK.
[CUSTOMER][POSITIVE] OK, no problem, hon. Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, so it was processed [PII], um, and it was denied. The reason for this denial is that benefits payable under the certificate are limited to those, yeah, outlined on the benefits.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the benefit is that like the, the benefits um
[CUSTOMER][NEUTRAL] Um, is, is that a max maxed out thing or non-covered like?
[AGENT][NEGATIVE] It's an uncovered thing, yeah, it looks like that that service is not covered. Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So the services are not covered. OK, perfect. Is there a claim number please, um, there a claim number?
[AGENT][POSITIVE] Correct, it's uh it's, yeah.
[AGENT][NEUTRAL] Um, yes, the claim number is 354.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 492 2.
[CUSTOMER][POSITIVE] OK, perfect. All [PII]. um I appreciate your help today, [PII]. You have a great day.
[AGENT][POSITIVE] You're welcome you as well.
[CUSTOMER][POSITIVE] And uh have a very happy and blessed New Year. Thank you so much. Take care.
[AGENT][POSITIVE] Yeah. Thank you.
[AGENT][POSITIVE] You as well, Ms. [PII]. Have a good day. Happy you. You're welcome. Bye-bye.
[CUSTOMER][POSITIVE] Thank you. OK. You too. Bye-bye. Bye-bye.