AccountId: 011433970860
ContactId: dbf403a5-72fd-4e03-86de-3a6eb9cee6e1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 287970 ms
Total Talk Time (AGENT): 116529 ms
Total Talk Time (CUSTOMER): 69562 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/dbf403a5-72fd-4e03-86de-3a6eb9cee6e1_20241230T19:14_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII] in the customer service department. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] calling from Newbury Hospital, and I have a claim here that you all denied, and I just wanna verify this is patients responsibility.
[AGENT][NEUTRAL] All right, Ms. [PII], before we proceed, is it possible to get a callback number in the event that we get disconnected?
[CUSTOMER][NEUTRAL] No problem area code [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And you said you had a denial that you received and you're just wanting to verify that it is the patient's responsibility due to the denial, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, do you have a patient's policy number so I can assist you further?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I have a um ID number.
[AGENT][NEUTRAL] OK, what is it?
[CUSTOMER][NEUTRAL] Uh, D as in dog.
[CUSTOMER][NEUTRAL] Oh wait a minute, D as in dog.
[CUSTOMER][NEUTRAL] 437322.
[CUSTOMER][NEUTRAL] 02.
[AGENT][NEUTRAL] OK, that sounds like it might be one of our third party carriers numbers. Um, do you happen to have their full name and I can look them up that way.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, yeah, I have a I have a policy number if you want me to give you that.
[AGENT][NEUTRAL] OK, what is it?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 025.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 6,464,040.
[AGENT][NEUTRAL] So you said 02564040?
[CUSTOMER][NEUTRAL] There are. Mhm.
[AGENT][NEUTRAL] OK. Thank you for that. And what's the patient's full name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right. I need you to verify a couple things for me so I can be able to assist you as well. Um, can you verify her date of birth and her mailing address, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Date of birth is [PII]. Billing address is [PII].
[AGENT][NEUTRAL] Thank you for that. OK, so her policy is active and I'm limited to what I can see as far as the denial. Um, is it OK if I transfer you to a claims representative and I'll make sure I get someone and release before I release you and provide all the details so you won't have to repeat all that again.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, that's fine.
[AGENT][NEUTRAL] All right. I'm gonna place you on a brief hold, Miss [PII]. Is there anything else I can help you with before you go?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] Alright, well thank you for calling APL. You have a wonderful day and hold please.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] Good morning. Thank you for call or good afternoon and thank you for calling American Public Life. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Hey, [PII], I have a provider on the back line that's inquiring about an insured's policy. Um, she recently received a denial from us and she's just wanting to verify the details on the denial and make sure the patient's responsible for the, I guess, balance.
[CUSTOMER][NEUTRAL] OK, what is that policy number?
[AGENT][NEUTRAL] 256-404-0
[AGENT][NEUTRAL] It's [PII], and I did verify everything. Provider's name is [PII].
[AGENT][NEUTRAL] And the callback number is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] 28.
[CUSTOMER][NEUTRAL] OK, and what's the provider's name?
[AGENT][NEUTRAL] She said her name was [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes, ma'am. That's the way I spelled it.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] All right, here she goes.