AccountId: 011433970860
ContactId: 9faa4364-c8d4-4b6a-9570-648e32fcb535
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 518169 ms
Total Talk Time (AGENT): 145469 ms
Total Talk Time (CUSTOMER): 134164 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/9faa4364-c8d4-4b6a-9570-648e32fcb535_20250529T20:16_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Uh, thank you so much. My name is [PII]. I need to check claim status.
[AGENT][NEUTRAL] OK [PII], I can help you with claim status. May I please get your callback number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. It's a direct line number.
[AGENT][NEUTRAL] Thank you, sir. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Policy number is 02.
[CUSTOMER][NEUTRAL] 45
[CUSTOMER][NEUTRAL] 36
[CUSTOMER][NEUTRAL] 81
[CUSTOMER][NEUTRAL] Patient name is [PII].
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you sir and let me pull up that policy real quick.
[CUSTOMER][NEUTRAL] OK, ma'am.
[AGENT][NEUTRAL] OK, and then may I have the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Uh, data service uh [PII]. Charge amount $5000 even.
[AGENT][NEUTRAL] OK and then what's the name of the facility you're calling for?
[CUSTOMER][NEUTRAL] Uh, facility name that is uh Saint Francis Side Hospital.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I look up this claim and I will be right back with you, [PII].
[CUSTOMER][POSITIVE] OK. No problem. Take your time.
[AGENT][POSITIVE] Thank you, sir. Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me, [PII]. So looking on data service of [PII], I do not find a claim on file.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For um.
[AGENT][NEUTRAL] That facility or that amount.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, uh, can you please confirm your policy effect to date?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] The effective date of the policy is [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And the policy terminated on [PII].
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK. Please confirm your mailing address.
[AGENT][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That is in [PII].
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, uh, can you please confirm the time finding limit for, uh, submit the claim?
[AGENT][NEGATIVE] We do not have a timely filing limit.
[CUSTOMER][NEUTRAL] OK, uh, thank you so much. Actually, I have a claim number. I have to claim number, but I'm a little bit confused this is claim for the correct claim number or I correctly um claim number. So I am providing you, so can you please little bit check on this one.
[AGENT][NEUTRAL] What is
[CUSTOMER][NEUTRAL] Yes, uh, claim number that is 202.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] 402
[CUSTOMER][NEUTRAL] 080
[CUSTOMER][NEUTRAL] 072.
[AGENT][NEUTRAL] OK, that is not an APL claim number.
[CUSTOMER][NEUTRAL] OK, another one that is 341.
[CUSTOMER][NEUTRAL] 863 1.
[AGENT][NEUTRAL] OK, let me look that up.
[CUSTOMER][NEGATIVE] This is also not
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, what is the amount on this one?
[CUSTOMER][NEUTRAL] Uh, this one is, I'm only able to see on the claim number, not able to find, uh, like any amount on any denial or any procedure for.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, alright, let me see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I do find that claim number and.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim was denied because the benefit maximum for the date of service was met.
[CUSTOMER][NEUTRAL] OK. So, uh, can you please confirm when it was made?
[CUSTOMER][NEUTRAL] Like, uh,
[CUSTOMER][NEUTRAL] Uh, how, how, how many we have already billed out how many we have changed.
[AGENT][NEUTRAL] Uh, let me see.
[AGENT][NEUTRAL] 8631
[AGENT][NEUTRAL] Uh, the claim was met.
[AGENT][NEUTRAL] In [PII].
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] I'm sorry, I apologize. It was the data service was, it was reported on [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] OK, 12.
[CUSTOMER][NEUTRAL] OK, that was the, uh, like that was made on date of service that is [PII], right?
[AGENT][NEUTRAL] The date of service that it was met on is [PII].
[CUSTOMER][NEUTRAL] OK, thank you so much. So please confirm your call reference number.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yes, you can use my name [PII]
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][NEUTRAL] OK, so, uh, a little bit, I'm sorry to interrupt you, ma'am. A little I'm I'm uh confused. There is, uh, you provided me [PII]. That is date of service or what or uh it was met on this date.
[AGENT][NEUTRAL] The date of service was [PII].
[CUSTOMER][POSITIVE] OK, OK, now I got it. Thank you so much, very much. Thank you. Bye for now. Have a great day.
[AGENT][POSITIVE] You're welcome. You're you have a great day too, [PII]. Thank you for calling APL. Bye-bye, sir.