AccountId: 011433970860
ContactId: cbf18df6-c6be-4ef2-9fbb-fb18ad659e77
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 240559 ms
Total Talk Time (AGENT): 96826 ms
Total Talk Time (CUSTOMER): 58687 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/cbf18df6-c6be-4ef2-9fbb-fb18ad659e77_20250521T20:26_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from Lehigh Valley Hospital. Calling to check the status on the medical claim.
[AGENT][NEUTRAL] Um, sure, [PII], I can assist you with claim status. Um, first, I'll need a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] [PII] direct line?
[AGENT][NEUTRAL] OK, thank you. Now, I need the policy number, please.
[CUSTOMER][NEUTRAL] Policy number is 02463192.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Um, [PII] last name [PII] [PII] [PII].
[AGENT][NEUTRAL] OK. Thank you and just let me advise you that verification of coverage does not guarantee payment of claims.
[AGENT][NEUTRAL] Um, and I'll need the date of service and bill charges for the claim you're calling about.
[CUSTOMER][NEUTRAL] [PII] for $15,0087.86.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, please repeat that date of service.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And these are the hospital charges for the ER visit?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Yes, ma'am. We received that claim on [PII].
[AGENT][NEUTRAL] Um, it processed on [PII].
[AGENT][NEUTRAL] The claim number is 35336777.
[AGENT][NEUTRAL] And I'm showing that this claim denied because um under this policy for outpatient services we cover up to.
[AGENT][NEUTRAL] 1000 per calendar year and that benefit had maxed out on a previous claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and any way I could get a fax or email copy of that EOB?
[AGENT][NEUTRAL] Um, yes, ma'am. I can fax it to you. What's your fax number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And so whose attention?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, so that's attention, [PII] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. You should receive it in about 10 minutes. I just sent it. Um, is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Do you have a call reference?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date. Um my name is [PII]. It's spelled [PII] and my last initial is [PII] and today's date.
[CUSTOMER][POSITIVE] OK, thank you so much and I hope you enjoy the rest of your day.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling APL bye.
[CUSTOMER][NEUTRAL] OK, bye.