AccountId: 011433970860
ContactId: d8a3dab9-46e1-4967-b26d-0ec840fc3a94
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 660169 ms
Total Talk Time (AGENT): 181193 ms
Total Talk Time (CUSTOMER): 194767 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/d8a3dab9-46e1-4967-b26d-0ec840fc3a94_20250102T15:06_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, did, what did you say your name was? I'm sorry.
[AGENT][NEUTRAL] My name is [PII] as well.
[CUSTOMER][NEUTRAL] OK, so my name is [PII] and I'm calling from Piedmont Augusta Hospital. I have some clients I need to check the status on.
[AGENT][NEUTRAL] Sure, I can assist you with [PII], and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Uh, D as in David 43716262.
[CUSTOMER][NEUTRAL] I have 2 clients for this patient.
[AGENT][NEUTRAL] Do you see a policy um certificate number? It's gonna start with a 0 followed by 7 digits.
[CUSTOMER][NEUTRAL] Oh, OK, let me, I gotta see if I have the card number on file then hold on, I'm going to the history.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I'll see if I have the card number, I mean the card on file.
[CUSTOMER][NEUTRAL] OK I do have the card. OK, here we go.
[CUSTOMER][NEUTRAL] OK, it says employee number it says employee name.
[CUSTOMER][NEUTRAL] I don't show
[CUSTOMER][NEUTRAL] I don't show this, um.
[CUSTOMER][NEUTRAL] OK, let's try this again.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I it's showing a different name.
[CUSTOMER][NEUTRAL] OK, let's see here you said it starts with uh the number starts with what? 00?
[AGENT][NEUTRAL] It starts with 0 followed by 7 digits.
[CUSTOMER][NEUTRAL] I'm not showing that number in here like that.
[AGENT][NEUTRAL] No, um, let's do a name search. We can do a name search. Um, what's the spelling of the last name?
[CUSTOMER][NEUTRAL] For this patient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The name is [PII], [PII]
[AGENT][NEUTRAL] OK, and what's the spelling of the first name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] No, that's [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is her date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, I found it. All right. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] The first one is 94 of 2024 and the amount of the claim is 12,15145.
[AGENT][NEUTRAL] OK, let's try that one.
[AGENT][NEUTRAL] That was [PII] correct?
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, here it is. Let me pull this EOB and for future you can check claim status online through our website at [PII] and that's just optional and let's see.
[AGENT][NEUTRAL] OK, looks like we processed the claim on [PII] and we send a benefit amount of $75 to the provider. $75 is the maximum we pay for an ER visit. This is a limited policy.
[CUSTOMER][NEUTRAL] OK, so $75 and that was paid when?
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] OK, and that is the max you can pay for a, a ER visit?
[AGENT][NEUTRAL] ER ER visit, correct. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, what's that claim number?
[AGENT][NEUTRAL] Claim number is 3541213.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I do have another one. Do you wanna give me one reference number or separate reference numbers?
[AGENT][NEUTRAL] We don't have reference numbers. You use my name in today's date if you will.
[CUSTOMER][NEUTRAL] What is the first initial to your last name?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] OK, alright, the next state of service for this patient is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right. Let me pull the ERP.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Let me see when we process that one because it's not pulling up it looks like we recently processed that um yep, I.
[AGENT][NEUTRAL] today. Let me double check.
[AGENT][NEUTRAL] Yeah, it looks like they're working on it today, um, but it seems like it's gonna be denied. Um, let me check that now. I'll be some really quick, OK, one moment.
[AGENT][NEUTRAL] OK, so, um, it was, uh, it looks like it's being denied based on the maximum benefit for the outpatient sickness rider has been exhausted for the calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, what is that claim number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim number is gonna be 3546728.
[CUSTOMER][NEUTRAL] 672-8. OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, and can and so I just used your name for the reference on that one also, right?
[AGENT][POSITIVE] Correct, yes. Mhm.
[CUSTOMER][NEUTRAL] OK, alright, let me go to the next one.
[CUSTOMER][NEUTRAL] Alright, the next one.
[AGENT][NEUTRAL] And it's the same number?
[CUSTOMER][NEUTRAL] Uh, it's a different member.
[AGENT][NEUTRAL] OK, so let me go ahead and finalize this number. Let me make a note to one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what is the next policy number?
[CUSTOMER][NEUTRAL] A as in Apple 202-96612
[AGENT][NEUTRAL] OK, that's not our number. Do you have any other numbers?
[CUSTOMER][NEUTRAL] Uh, let me see if there's a card on file. Hold on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, looks like we do have a car.
[CUSTOMER][NEUTRAL] Members's number, that's what he's saying A.
[CUSTOMER][NEUTRAL] Yeah, it's saying that's it, A as in apple 202-96612.
[AGENT][NEUTRAL] Is it for APL American Public Life?
[CUSTOMER][NEUTRAL] It says
[CUSTOMER][NEUTRAL] High card, whatever that means, and it says any questions call it's got the number it's got [PII] on it.
[AGENT][NEUTRAL] OK, yeah, that may be different. I it, it doesn't have her number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, no, it doesn't have, uh, your phone, the phone number I just called, no.
[CUSTOMER][NEUTRAL] It has another phone number I guess I need to call that number.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah, because it sounds like it's just the 90 degrees. It doesn't have our, our information on that one. It's two separate ones, mhm.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, well I, I'll give them a call again. Thank you.
[AGENT][NEUTRAL] You're welcome. Is there anything else I may help you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] Let me make sure I don't have any more claims that says um 90 degree.
[AGENT][NEUTRAL] Mm. Sure, yes.
[CUSTOMER][NEUTRAL] Hold on.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] 90 degrees. OK.
[CUSTOMER][NEUTRAL] That's the one I just, OK, I have another one. Let's check that one before we hang up.
[AGENT][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] OK, alright, this one is, let's see if it what the policy number is.
[CUSTOMER][NEUTRAL] Policy number is, it's a number that says A as in apple, so I guess I need to call that number for that one also.
[AGENT][NEUTRAL] Yeah, if it doesn't have anything else, but that, yeah, it's, it's probably 90 degrees.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is another 90 degree. OK, let me see if I have a moment. OK, that's it. Thank you very much.
[AGENT][POSITIVE] You're welcome, Ms. [PII], and thank you for calling APO. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][POSITIVE] Thank you.