AccountId: 011433970860
ContactId: da16192d-1554-4b83-994e-9c8a1a19e8cc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 308940 ms
Total Talk Time (AGENT): 133443 ms
Total Talk Time (CUSTOMER): 70283 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/da16192d-1554-4b83-994e-9c8a1a19e8cc_20250211T14:08_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning [PII]. My name is [PII] and I'm calling from University Hospital Medical Group for claim status.
[AGENT][NEUTRAL] Yes, ma'am. OK, [PII], you're needing claim status. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII] direct line.
[AGENT][NEUTRAL] Thank you. And how many claims, [PII], do you have to check status on today?
[CUSTOMER][NEUTRAL] Just one.
[AGENT][NEUTRAL] OK, yes ma'am. I can help you. And what is the member's policy number, please?
[CUSTOMER][NEUTRAL] 02566961
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Patient is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I want to pay the service and total bill amount for her.
[CUSTOMER][NEUTRAL] [PII] with a total charge of $46.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK just one moment for me to look at just a couple of things, please.
[CUSTOMER][POSITIVE] Oh, no rush. Take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so I can see this claim was received. The received date on this claim is
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] One second, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it was processed on [PII]?
[AGENT][NEUTRAL] The claim number is 3556889.
[AGENT][NEGATIVE] And this claim was denied.
[AGENT][NEUTRAL] And the reason for the denial on the claim, [PII]?
[AGENT][NEUTRAL] Both remarks are the same. It states.
[AGENT][NEUTRAL] Outpatient services are not covered under this policy.
[CUSTOMER][NEUTRAL] OK, and is this a patient responsibility?
[AGENT][NEUTRAL] We do not determine patient responsibility, that would be up to the provider.
[CUSTOMER][POSITIVE] OK, got it. Thank you so much.
[AGENT][NEUTRAL] And then, yes ma'am, and [PII], one last thing, I'm not sure if you're aware of our portal, but we do have a portal that you should be able to check claim status also or have and also have access.
[CUSTOMER][NEUTRAL] Yeah, I
[AGENT][NEUTRAL] You have that?
[CUSTOMER][NEGATIVE] Yeah, I, I tried to register this morning, but it kept telling me the link was invalid, so that's why I ended up calling.
[AGENT][NEUTRAL] OK, and you were just typing in [PII]?
[CUSTOMER][NEUTRAL] Hold on one second. I was typing in what.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Insurance card, hold on, let me pull the card up.
[AGENT][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] You don't have to do all that. Yeah, you don't, you can just, you can't, but you can just type in [PII] and it should take you to the proper page.
[CUSTOMER][NEUTRAL] Oh, that's that's probably why.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it
[CUSTOMER][POSITIVE] OK, thank you so much. Can I have a reference number?
[AGENT][POSITIVE] Sure, you're gonna use my name along with today's date, [PII]. And is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, thank you. Enjoy the rest of your day.
[AGENT][POSITIVE] I hope you do too, and thank you again for calling APL.