AccountId: 011433970860
ContactId: c1e1fd23-8354-4c31-890e-5e92a8e9fba7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 604599 ms
Total Talk Time (AGENT): 111703 ms
Total Talk Time (CUSTOMER): 94623 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=-2.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/c1e1fd23-8354-4c31-890e-5e92a8e9fba7_20250424T18:53_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] calling from provider's office for checking on a claim.
[AGENT][NEUTRAL] OK, sure. I can assist you with claims and how do you spell your name?
[CUSTOMER][NEUTRAL] [PII] And could you please spell your name?
[AGENT][NEUTRAL] That's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure. Callback number is [PII].
[AGENT][NEUTRAL] Thank you. And what's the name of the facility you're calling from, Miss?
[CUSTOMER][NEUTRAL] It is going to be, yeah, it's going to be Saint Thomas Hospital for specialty surgery.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Patients uh policy is going to be
[CUSTOMER][NEUTRAL] 02319989
[AGENT][NEUTRAL] 19985.
[AGENT][NEUTRAL] OK. What's
[CUSTOMER][NEUTRAL] Uh, no, I'll do you want to repeat it?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] 02319989
[AGENT][NEUTRAL] OK. What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Name of the member is [PII], and the date of birth is going to be [PII].
[AGENT][POSITIVE] Perfect, thank you.
[AGENT][NEUTRAL] All right. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Date of service is going to be [PII]. Total charges is $76,180.74.
[AGENT][NEUTRAL] OK, thank you. So that was [PII], correct?
[CUSTOMER][POSITIVE] Uh, that's right.
[AGENT][NEUTRAL] OK. Let me see if I can find this claim for you. And for the future, you can check claim status online through our website at [PII] and that's just optional. And bear with me, let me pull this ELB, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] I'm still waiting on that you'll be.
[AGENT][NEUTRAL] It looks like we received a claim on [PII], processed on [PII].
[AGENT][NEUTRAL] And the claim was denied. The reason for this denial, it looks like is outpatient benefits for the calendar year has been met.
[CUSTOMER][NEUTRAL] OK. And is it possible that you could fax us a copy of the uh EOB?
[AGENT][NEUTRAL] Yes, what is the fax number?
[CUSTOMER][NEUTRAL] It is [PII]. Attention to my name, [PII].
[AGENT][NEUTRAL] OK, so that's [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me. Yeah, I went ahead and send that over to you should be there in a few minutes. Is there anything else I may help you with today?
[AGENT][NEUTRAL] Hello?
[AGENT][NEUTRAL] Ms. [PII].
[CUSTOMER][NEUTRAL] Yes, can you hear me now?
[AGENT][NEUTRAL] Oh, yes, I can hear you now.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And uh could you please provide me the call reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][POSITIVE] OK, thank you very much for helping me with this, and yes, yeah, have a great day ahead.
[AGENT][POSITIVE] Exactly.
[AGENT][POSITIVE] You as well, Ms. [PII], and thank you for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm.