AccountId: 011433970860
ContactId: c6190997-42fc-47eb-b2e2-e02928d79ff6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 609000 ms
Total Talk Time (AGENT): 173274 ms
Total Talk Time (CUSTOMER): 140299 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/c6190997-42fc-47eb-b2e2-e02928d79ff6_20250117T16:24_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL this is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, my name is calling from provider office checking on claim status.
[AGENT][NEUTRAL] What was your name?
[CUSTOMER][NEUTRAL] It's [PII]. It's [PII].
[AGENT][NEUTRAL] OK ma'am, can I get a good call back number?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][POSITIVE] OK, thank you ma'am. Can I
[CUSTOMER][NEUTRAL] Could you please tell me your name once? On, could you please spell the name?
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] Ma'am, can I get the policy number?
[CUSTOMER][NEUTRAL] Yeah. It's 01816171.
[AGENT][NEUTRAL] OK, thank you ma'am. Can you confirm the insured's name and date of birth for me?
[CUSTOMER][NEUTRAL] My name is Saint Mary's Good Samaritan Hospital, Greensboro.
[AGENT][NEUTRAL] No, ma'am. I, I mean the the patient. I need the patient's name and date of birth.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK, and you said you're calling to check claim status. I can definitely take a look. What is that data service and build amount?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. And the charger amount is $16,254.55.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, uh, bear with me here for just a minute.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see if this claim is the one we have on file.
[AGENT][NEUTRAL] Uh, give me just a second. It's loading.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I do have a claim number for you.
[CUSTOMER][NEUTRAL] Yeah, I was.
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] Um, 352-861-0.
[AGENT][NEUTRAL] Give me just a second.
[AGENT][NEUTRAL] It looks like it was received [PII]. It was processed [PII], and it did process and pay $1140.40.
[CUSTOMER][NEUTRAL] Please switch on.
[AGENT][NEUTRAL] Ma'am?
[CUSTOMER][NEUTRAL] Yeah, this amount, which amount?
[AGENT][POSITIVE] That's the benefit that it paid.
[CUSTOMER][NEUTRAL] Benefit
[CUSTOMER][NEUTRAL] Yeah, may I know the check number?
[AGENT][NEUTRAL] I'm, I'm sorry, could you please repeat that?
[CUSTOMER][NEUTRAL] Yeah, check number.
[AGENT][NEUTRAL] The check number is 2013286.
[AGENT][NEUTRAL] And that check cleared on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah, just a moment.
[CUSTOMER][NEUTRAL] Yeah, is it single check or bulk check?
[AGENT][NEUTRAL] It's a single check.
[CUSTOMER][NEUTRAL] Yeah. Could you please update the UOB through the fax?
[AGENT][NEUTRAL] OK, what is the fax number?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Attention
[CUSTOMER][NEUTRAL] No, there is no I think.
[AGENT][NEUTRAL] OK, yes ma'am, as long as your fax machine is clear, the EOB should receive um in about 30 minutes. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Yeah. My name, sorry. May I know the call reference number?
[AGENT][NEUTRAL] It's gonna be my name [PII] with the first initial to my last name, [PII], and today's date.
[CUSTOMER][NEUTRAL] Yeah, [PII], I have another plan. Could you please help me with that?
[AGENT][POSITIVE] OK, give me just a second, let me get this EOB started so we can get this sent over for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is it for the same member?
[CUSTOMER][NEUTRAL] No, different number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Bear with me for just a minute.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm in the process of getting this faxed sent to you now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So give me just a second here.
[AGENT][NEUTRAL] OK, what is that policy number for the next member?
[CUSTOMER][NEUTRAL] Yeah, the policy number is 1330836 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] Members's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Data service and build out.
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the billing amount is $3,252.75.
[AGENT][NEUTRAL] OK, so I have a claim number for you. The claim number is 352-228-5.
[AGENT][NEUTRAL] That claim was received [PII], 24, processed [PII].
[AGENT][NEUTRAL] Uh, give me just a second.
[AGENT][NEUTRAL] OK, so it denied stating that the outpatient benefits for this calendar year has been met.
[CUSTOMER][NEUTRAL] How much amount?
[AGENT][NEUTRAL] Uh, give me just a second.
[AGENT][NEUTRAL] Um, they're allowed $750 per calendar year per um per person, and it looks like those have been maxed.
[CUSTOMER][NEUTRAL] Yeah, actually, primary insurance transfer the amount is $300 only to the secondary insurance.
[AGENT][NEUTRAL] Right, but the benefits have been maxed for the secondary insurance.
[CUSTOMER][NEUTRAL] Yeah, yeah, how much amount? 750?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] 50, OK.
[CUSTOMER][NEUTRAL] Yeah. May I know the denial date?
[AGENT][NEUTRAL] Uh yes, give me just a second.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, just a moment.
[CUSTOMER][NEUTRAL] Yeah. I did not receive any EOB. Could you please fax through the UOB?
[AGENT][NEUTRAL] Yes, ma'am, to the same fax number?
[CUSTOMER][NEUTRAL] Yeah, same fax number.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, nothing. That's, that's it. Thank you for assisting me.
[CUSTOMER][POSITIVE] Have a great day. Thank you. Thank you a lot.
[AGENT][POSITIVE] You're welcome. Well thank you for calling APL. You have a great day as well. Bye bye.
[CUSTOMER][POSITIVE] Bye. Thank you. Bye.