AccountId: 011433970860
ContactId: cb9ed1b7-3160-4e22-850c-f3cca37edffe
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 508500 ms
Total Talk Time (AGENT): 135696 ms
Total Talk Time (CUSTOMER): 124834 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/cb9ed1b7-3160-4e22-850c-f3cca37edffe_20250423T16:02_UTC.wav
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[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] May I help you?
[CUSTOMER][NEUTRAL] Hello. Yes, hello. Good afternoon. My name is [PII], and I'm calling on behalf of a facility, and I was calling to see if a claim was processed using a network.
[AGENT][NEUTRAL] Hi.
[AGENT][NEUTRAL] OK, I can help you with a claim status. May I please get your name and your call back number just in case the call is disconnected?
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. It is [PII], and my direct number is [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII], and then what is um the name of the facility you're calling from please?
[CUSTOMER][NEUTRAL] Um, Pmont Augusta Hospital.
[AGENT][NEUTRAL] And may I please get the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] OK, it is in in y'all.
[CUSTOMER][NEUTRAL] Um, I'm gonna spell it. Um, the first name is [PII] Last name [PII]
[CUSTOMER][NEUTRAL] And their policy number is 2586493.
[AGENT][POSITIVE] OK, thank you so much and let me look that policy up real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I do show that the member does have an active policy. What is the data service of the claim?
[CUSTOMER][NEUTRAL] Alright, this is the data service [PII].
[AGENT][NEUTRAL] OK, and the charge amount, please?
[CUSTOMER][NEUTRAL] $84,07.48.
[AGENT][NEUTRAL] OK, Ms. [PII], I'm gonna put you on a quick hold while I look this claim up for us and I'll be right back.
[CUSTOMER][POSITIVE] OK, thanks.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] Oh, I don't want that.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you Mr. [PII]. So looking on data service of [PII], I do not find a claim on file.
[CUSTOMER][NEUTRAL] Um, well, we did receive a payment. I do have a claim number.
[AGENT][NEUTRAL] Oh OK can you please give that to me?
[CUSTOMER][NEUTRAL] Uh-huh. It is 3,561,840.
[AGENT][NEUTRAL] Alright, let me look and see.
[AGENT][NEUTRAL] Oh, I see why. We have a different, uh, policy number for that claim.
[AGENT][NEUTRAL] Let me give you the good policy number.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Uh, the policy number that that claim is under is 2311714.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then um I do show that the claim was paid $1800 with check number 2027243.
[AGENT][NEUTRAL] And after that payment let's say we've got some denial codes, the maximum benefit payable for the data service was exhausted.
[CUSTOMER][NEUTRAL] OK, but was they um did they use the multi-plan um network to process this claim or was it processed as non, um, not a network?
[AGENT][NEUTRAL] No, they would use the multi plan to process it because we're it went through APL.
[CUSTOMER][NEUTRAL] OK. OK. All right. OK. So I did submit um an appeal, but we never received a response. So I'll just um allow more time to see if they'll respond to it. Um, is there any way you can check to see if you received it or do I need to reach out to APL directly?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, let me look real quick and see, um, what day did you submit it?
[CUSTOMER][NEUTRAL] Um, it was mailed out back on [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, I'm looking to see.
[AGENT][NEUTRAL] It's gonna be just a minute. There's a lot, this patient has a lot of dates.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I do show that it was received but we are still in the process of the appeal.
[CUSTOMER][POSITIVE] OK. Yeah. OK. All right, thank you so much. And can I have your name again and a reference number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, my name is [PII] and you can use my name and today's date as a reference number.
[CUSTOMER][POSITIVE] All right. Thank you so much, [PII]. I really do appreciate your help.
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. I hope you have a wonderful day. Is there anything else I can help you with before we go?
[CUSTOMER][POSITIVE] No, that'll be all. Thank you.
[AGENT][POSITIVE] OK. You, thank you for calling APL. You have a good day. Bye-bye.
[CUSTOMER][POSITIVE] Oh, you welcome. You too. Bye-bye.