AccountId: 011433970860
ContactId: b876cbfd-0902-4545-a45f-922500cc3dc6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 424299 ms
Total Talk Time (AGENT): 168669 ms
Total Talk Time (CUSTOMER): 91825 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/b876cbfd-0902-4545-a45f-922500cc3dc6_20250602T17:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] I'm sorry. Well, my name is [PII], and I need to see if I'm a claiming the please.
[AGENT][NEUTRAL] OK, and you said your name was [PII]?
[CUSTOMER][NEUTRAL] [PII], excuse me.
[AGENT][NEUTRAL] [PII]. OK, Ms. [PII], I can help you with claim information. May I please get your call back number, ma'am, just in case the call is dropped.
[CUSTOMER][NEUTRAL] Uh huh, it's [PII].
[CUSTOMER][NEUTRAL] [PII] and my extension is [PII].
[AGENT][NEUTRAL] Thank you. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Uh, his name is [PII]. Date of birth is [PII]. Policy ID I have is D as in David 45,902,380.
[AGENT][NEUTRAL] OK, do you see um an APL policy number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I don't have a copy of the insurance card. Um, hold on.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. What about the um social? Do you have the social so I can pull them up?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm I have a social number [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Let me pull him up real quick.
[AGENT][NEUTRAL] OK and um what kind of uh.
[AGENT][NEUTRAL] Claim is this for for?
[AGENT][NEUTRAL] What kind of procedure? It's um he's got several different policies. Is it for dental or hospital?
[CUSTOMER][NEUTRAL] I was uh I'm.
[AGENT][NEUTRAL] Medical
[CUSTOMER][NEUTRAL] Hotel.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Alright, let me go ahead and give you the policy number that we have so that you'll have that for yourself.
[CUSTOMER][POSITIVE] Oh thank you.
[AGENT][NEUTRAL] You're very welcome. The APL policy number is 191.
[AGENT][NEUTRAL] 4305.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then what is the date of service?
[CUSTOMER][NEUTRAL] It's gonna be [PII].
[AGENT][NEUTRAL] And the charge amount please?
[CUSTOMER][NEUTRAL] $11,410.
[AGENT][NEUTRAL] OK, so you said $11,410?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, let me look it up here first. If, if I don't have it in our system, then I'll need to transfer you to 90 degree Benefits and they'll be able to assist you further, but I'm gonna check here real quick.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] OK, I do see it. Let me pull it up real quick.
[AGENT][NEUTRAL] OK, and what's the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] I'm sorry, the facility is North Austin Medical Center.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so this policy right now we're waiting on eligibility from benefits and a card.
[AGENT][NEUTRAL] Um, once we receive the eligibility for that date of service, we'll reprocess the claim automatically.
[CUSTOMER][NEUTRAL] OK, what is, can you give me, do you have a claim number?
[AGENT][NEUTRAL] Uh yes, ma'am. It is 3608051.
[AGENT][NEUTRAL] Oh wait, I'm looking at this policy and it's probably not going to reprocess. Let me investigate this a little further.
[AGENT][NEUTRAL] Yeah, this policy is, is the claim is not gonna be able to be reprocessed because the uh termination date of the policy is [PII].
[AGENT][NEUTRAL] So the member was not active on the date of service yeah.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and what was the denied date or the received date was received and denied.
[AGENT][NEUTRAL] Let me get that for you real quick.
[AGENT][NEUTRAL] We received the claim on [PII] and processed it on [PII].
[CUSTOMER][NEUTRAL] Today?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] And I'm sorry, what was your name? I didn't catch your name at the beginning. What was your name?
[AGENT][NEUTRAL] My name is [PII], it's [PII]
[CUSTOMER][NEUTRAL] Alright thank you. And if you don't mind it, do you have a call reference I could use?
[AGENT][NEUTRAL] Yes ma'am, you can use my name and today's date.
[CUSTOMER][POSITIVE] Thank you so much, enjoy the rest of your day.
[AGENT][POSITIVE] You enjoy yours too, Ms. [PII]. Is that everything I can help you with before we go?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] No, that's it, that is everything.
[AGENT][POSITIVE] All right. OK, well thank you for calling APL and you have a good rest of your week. Bye bye, ma'am.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You too thanks bye bye.
[AGENT][POSITIVE] Mhm. Thank