AccountId: 011433970860
ContactId: 9241a8b5-8a54-4b3d-a8b5-c8b67894150f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 474839 ms
Total Talk Time (AGENT): 170887 ms
Total Talk Time (CUSTOMER): 129616 ms
Interruptions: 4
Overall Sentiment: AGENT=0.6, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/9241a8b5-8a54-4b3d-a8b5-c8b67894150f_20250326T17:56_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] [PII], hi there. Good afternoon. My name is [PII]. I am calling to get the status of a claim, please.
[AGENT][NEUTRAL] OK, Ms. [PII], I can help you with the claim status. Can you please give me your call back number?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] It is direct [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] This is for [PII], I believe it is uh [PII].
[AGENT][NEUTRAL] And then what is the patient's policy number?
[CUSTOMER][NEUTRAL] It is 142-0381 M as in Mary, L as in Lima 8.
[AGENT][NEUTRAL] OK, let me pull that policy in for us real quick.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] OK, can you please give me the date of service and the charge amount?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[CUSTOMER][NEUTRAL] 56,54364
[AGENT][NEUTRAL] OK, and then what's the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Um, uh.
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] 3,431 86
[AGENT][POSITIVE] Thank you. And can you give me.
[CUSTOMER][NEUTRAL] That's the member's responsibility.
[AGENT][NEUTRAL] OK, and then can you give me the name of the facility you're calling from Miss [PII]?
[CUSTOMER][NEUTRAL] Mhm. Both of which are Regional Hospital.
[AGENT][POSITIVE] OK, I'm gonna put you on a quick hold so I can look up this claim for you. You're welcome and I'll be right back.
[CUSTOMER][POSITIVE] Thank you, sir.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Miss [PII], this is [PII] back with you.
[AGENT][NEUTRAL] So looking on data service of [PII], I do not find a claim on file for the amount that you have given me.
[AGENT][NEUTRAL] Miss [PII], are you there?
[AGENT][NEUTRAL] Hello Ms. [PII].
[CUSTOMER][NEUTRAL] [PII], I'm sorry. I had you on mute and talking to you. Pardon me. I'm like.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] That's OK. I've done that. I've done that myself.
[CUSTOMER][NEUTRAL] It's after you came back and said, Miss [PII], I'm like, oh my God, I'm talking and I'm on mute. But um, yeah, but by chance do you see one there for data service?
[CUSTOMER][NEUTRAL] Oh, let me see what they have.
[CUSTOMER][NEUTRAL] So are you seeing by chance any claim on file at all? So around that time?
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] I do, but it's for outpatient.
[AGENT][NEUTRAL] Um, let me see if it's even for you. Let me check real quick.
[CUSTOMER][NEUTRAL] Mm, this.
[CUSTOMER][NEUTRAL] Mhm. OK, thanks.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEGATIVE] Yeah, it's not even for your facility.
[CUSTOMER][NEUTRAL] OK. So the address, um,
[AGENT][NEUTRAL] Oh, wait, wait, wait, wait, wait, wait, I do see one for you. I'm sorry. They have it abbreviated. I apologize. Um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] B R H something like that.
[AGENT][NEUTRAL] Yes, yes. And then, and then mail code. So I didn't need to look at, yes, ma'am. Let me uh pull this up real quick.
[CUSTOMER][NEUTRAL] B R R H.
[AGENT][NEUTRAL] Um, well, it's saying that the total paid was $4.84.
[CUSTOMER][POSITIVE] Mhm thank you.
[AGENT][NEUTRAL] With check number 203-415-1.
[AGENT][NEUTRAL] And um let me see what the remarks on. I apologize for that. um.
[CUSTOMER][POSITIVE] OK, it's OK. Take your time.
[AGENT][NEUTRAL] OK, so we've got um a couple of remarks on it for the reason for denial.
[AGENT][NEUTRAL] The insured's major medical coverage provided full benefits, no benefits are payable, and then the maximum benefit payable for this data service was met.
[CUSTOMER][NEUTRAL] So in a sense primary paid more than allowed.
[AGENT][NEUTRAL] Right, and
[AGENT][NEUTRAL] The payment that went out was in the amount of $4.84 check number 2034151.
[AGENT][NEUTRAL] And let me see if there was.
[AGENT][NEUTRAL] And it was sent out on [PII].
[AGENT][NEUTRAL] Of [PII].
[CUSTOMER][NEUTRAL] OK, thanks. uh, it pays $4.80?
[AGENT][NEUTRAL] $4.84.
[CUSTOMER][NEUTRAL] 224
[CUSTOMER][NEUTRAL] And the check number 203-4151, um, may I have the claim number please?
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes ma'am, I get that to you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] It is 357-837-78.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All righty, and thank you. May I have a reference number for our call?
[AGENT][NEUTRAL] Yes ma'am, you can use my name.
[AGENT][NEUTRAL] [PII] and today's date.
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] Why
[CUSTOMER][NEUTRAL] How do you spell that?
[CUSTOMER][POSITIVE] Alright, OK, thank you so much, [PII]. I appreciate it. Have a good rest of your day.
[AGENT][POSITIVE] You too, Ms. [PII]. You have a good day also. Thank you for calling APL.
[CUSTOMER][POSITIVE] All right. Thanks, bye bye.
[AGENT][NEUTRAL] Mhm. Bye-bye.