AccountId: 011433970860
ContactId: a2a3275e-40ec-475b-a296-b58abd1167a0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 317329 ms
Total Talk Time (AGENT): 94280 ms
Total Talk Time (CUSTOMER): 176098 ms
Interruptions: 6
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/a2a3275e-40ec-475b-a296-b58abd1167a0_20250305T14:14_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling for Samaritan Hospital to check on a clean status. Please be informed that this call is being recorded and monitored for quality training purposes.
[AGENT][NEUTRAL] Sure, I can assist you with claims Mr. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sure, my callback number it's gonna be [PII] and no extensions is a direct connect.
[AGENT][NEUTRAL] OK, thank you. And what is the patient's policy number?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sure, the patient's policy number is gonna be 13308133083.
[CUSTOMER][NEUTRAL] 6 M as in Mike. L as in Lima, 8.
[CUSTOMER][NEUTRAL] Oh my phone's coming.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Mhm OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's just.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Sure the patient's name is gonna be [PII] and the date of birth is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] the
[AGENT][NEUTRAL] And may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Sure, the date of sale is gonna be [PII], with the total bill amount of $5,552.75.
[CUSTOMER][NEUTRAL] No, I don't.
[AGENT][NEUTRAL] OK. Thank you. Let me see if I can find this claim for you and that was [PII], the amount of 55275. Is that correct?
[CUSTOMER][POSITIVE] Yeah, you're right.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Are you available for the.
[AGENT][NEUTRAL] And for future you can check claim status online through our website at [PII] and that's just optional.
[CUSTOMER][NEUTRAL] Hello, yeah, I, I remember.
[CUSTOMER][NEUTRAL] I don't know.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, let me pull this EB one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Also
[AGENT][NEUTRAL] OK, so it looks like we processed the claim [PII].
[AGENT][NEUTRAL] And the claim was denied. The reason for this denial is
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Outpatient benefits for the calendar year has been met.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, and could you please uh let me know when, when the patients or patient benefit was, uh, met, and the date or the claim?
[CUSTOMER][NEUTRAL] When it was met.
[AGENT][NEUTRAL] OK, we cannot release the information that doesn't pertain to your claim. I can only give you information pertaining to your claim. So that information that you're asking for, we cannot release.
[CUSTOMER][NEUTRAL] All right, OK. Just some uh, so in this case that because the patient doesn't have a patient benefits, so can we bill the patient for?
[AGENT][NEUTRAL] It's it's up to the provider's discretion. We don't have any contractual involvement on the remaining of the claim, so it's up to the provider's discretion.
[CUSTOMER][NEUTRAL] The balance.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] All right, OK, just, OK, could you please spell your name for me?
[AGENT][NEUTRAL] Sure. My name is [PII]'s [PII].
[CUSTOMER][POSITIVE] Thank you. So thank you so much for the information.
[CUSTOMER][NEUTRAL] Alright, OK, I don't have any more questions, and can I have the call reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you would like.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Right. Bye. Thank you so much for assisting me. Have a great day.
[AGENT][POSITIVE] You as well, Mr. [PII]. Thank you for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah