AccountId: 011433970860
ContactId: b1fe5707-15f5-4922-aa73-0cfa67a06f41
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 289959 ms
Total Talk Time (AGENT): 88111 ms
Total Talk Time (CUSTOMER): 98815 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/b1fe5707-15f5-4922-aa73-0cfa67a06f41_20250306T17:46_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm with Baptist Health Medical Group, and I'm calling to get some information on a claim we've submitted for a patient.
[AGENT][POSITIVE] OK, [PII], I'm happy to check on a claim for you. Do we have their policy number?
[CUSTOMER][POSITIVE] Yes, I do. It is.
[CUSTOMER][NEUTRAL] Um, 1255983 M as in Michael.
[CUSTOMER][NEUTRAL] L as in Lima, 8.
[AGENT][POSITIVE] Alright, thank you so much.
[AGENT][NEUTRAL] And if I can get patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, this is, first name is [PII]
[CUSTOMER][NEUTRAL] Um, hold on, I'm sorry, my system.
[AGENT][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] It's frozen
[CUSTOMER][NEUTRAL] OK, um, let's see, [PII], uh, date of birth is [PII].
[AGENT][NEUTRAL] Alright and then what's the data service?
[CUSTOMER][NEUTRAL] I'm looking for 15 of 24.
[AGENT][NEUTRAL] All right. And then do we have build them out?
[CUSTOMER][NEUTRAL] Mhm it's 100 0 wait sorry that's the wrong one. It is $402.
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] $42.
[AGENT][NEUTRAL] OK. So it looks like we did get a claim for this [PII]. uh, the claim, it looks like was received on, I don't know if you need the received date.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um, it looks like it was received on [PII]. Um, it looks like the claim was denied stating that the calendar year max for the outpatient benefit has already been met.
[AGENT][NEUTRAL] So let me see
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it looks like their outpatient benefit max for the calendar year is 3500.
[CUSTOMER][NEUTRAL] OK, alright, um, well, let me ask, um.
[CUSTOMER][NEUTRAL] Do you, do you show like maybe the EOB?
[CUSTOMER][NEUTRAL] Was sent and possibly maybe the address that it was sent to or let let me ask this and said can I get a copy of that EOB emailed or faxed to me?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yeah, I can fax it to you absolutely.
[CUSTOMER][POSITIVE] OK, great.
[AGENT][NEUTRAL] What is the uh fax number?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And just send that to my attention, [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And are you showing any patient responsibility on that?
[AGENT][NEUTRAL] Yeah, so we're not able, yeah, we're not able to advise on the responsibility that's up to the facility or provider.
[CUSTOMER][NEUTRAL] Oh wait, no, I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right, I'm sorry I'm, I totally forgot what the the processing reason was OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Alright, um, OK, well, I will look for that fax. If I could get maybe a reference number for the call, I think that'll be it.
[AGENT][NEUTRAL] Yeah, absolutely. So fax is on its way, should be there in about 5 minutes and then the call reference is going to be my name with my last initial in today's date. My name again is [PII], and then my last initial is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much. Have a great day.
[AGENT][NEUTRAL] You too bye bye.
[CUSTOMER][POSITIVE] Thank