AccountId: 011433970860
ContactId: dbff0bad-1712-40aa-a96d-0aaefa19d8d9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 323890 ms
Total Talk Time (AGENT): 142312 ms
Total Talk Time (CUSTOMER): 112575 ms
Interruptions: 4
Overall Sentiment: AGENT=0.6, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/dbff0bad-1712-40aa-a96d-0aaefa19d8d9_20250203T17:27_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] again. I'm calling from Prisma Health.
[CUSTOMER][NEUTRAL] And I have a claim that I need to see if a patient had coverage through APL.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Sure, OK, yeah, I can check on a claim for you, [PII]. um, can I get that callback number from you again real quick just in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Yes, um.
[CUSTOMER][NEUTRAL] I believe you needed the social when I talked to you last. Let me get the social no, hang on.
[AGENT][NEUTRAL] Oh, is this for that same number?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, yeah, if you wouldn't mind giving me that social.
[CUSTOMER][NEUTRAL] Hang on.
[CUSTOMER][NEUTRAL] OK, hang on.
[CUSTOMER][NEUTRAL] Oh Lord.
[CUSTOMER][NEUTRAL] It's for different data service. It was it was earlier in the year.
[AGENT][POSITIVE] I'll make sure I give you that
[AGENT][POSITIVE] I'll make sure I give you that policy number this time too. I apologize.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Um, it's 247-87.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 0600.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you may have given it to me.
[AGENT][NEUTRAL] OK, uh, her date of birth for me if you wouldn't mind.
[CUSTOMER][NEUTRAL] Mhm [PII].
[AGENT][NEUTRAL] OK, just a moment.
[AGENT][NEUTRAL] There we are. OK, let me go ahead and give you that policy number first, um, so it is 02.
[AGENT][NEUTRAL] 54
[AGENT][NEUTRAL] 5013.
[CUSTOMER][POSITIVE] OK, perfect, thank you.
[AGENT][NEUTRAL] Mhm OK and then what was the date of service please?
[CUSTOMER][NEUTRAL] 3.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and that bill out please.
[CUSTOMER][NEUTRAL] $5,243.50.
[AGENT][NEUTRAL] OK, thank you. Alrighty, I'm gonna have to go back to see if she had an older policy as this one's effective date was [PII]. Bear with me just a moment.
[CUSTOMER][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] OK, so looks like she did have one active at that time. Bear with me just a moment let me try to find it.
[AGENT][NEUTRAL] OK, so I did find this claim, [PII], bear with me just a moment.
[AGENT][NEGATIVE] So we were unable to pay a benefit. Uh, it states the outpatient, uh, benefit only allows payment for outpatient surgery in an outpatient hospital or a physician's office, therefore no benefits are payable.
[CUSTOMER][NEUTRAL] Outpatient surgery or, or what now?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I could send you this EOB too so you've got um an actual reference uh of course and I will repeat that but um yes you have a fax number?
[CUSTOMER][POSITIVE] Oh, that would be perfect, yep, yep, yep, so.
[CUSTOMER][NEUTRAL] Yes, 864.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 522.
[CUSTOMER][NEUTRAL] 958 7.
[AGENT][NEUTRAL] OK, and then
[CUSTOMER][NEUTRAL] So it doesn't cover just ER that's that's that's what I'm getting at.
[AGENT][NEUTRAL] Right, yes, yes, um, OK, and would I just put this to your attention, [PII]?
[CUSTOMER][POSITIVE] Yes, that would be great.
[AGENT][NEUTRAL] OK, let me go ahead and get that sent to you now really quick.
[CUSTOMER][NEUTRAL] And I'm looking to make sure I'm finished with her.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, it's OK.
[CUSTOMER][NEUTRAL] Yep, this is my last claim on her.
[CUSTOMER][NEGATIVE] And and and with these that is APL for certain dates and then it might switch to the 90 degree benefits to oh Lord, that that that makes the that makes a denials and appeals specialist representative makes my mind blow up.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEGATIVE] These multi plans, yeah, they are very confusing.
[AGENT][NEUTRAL] See, and I, I can imagine, yeah, it's a one.
[CUSTOMER][POSITIVE] You know the little emoji with that little mind blowing up.
[CUSTOMER][NEUTRAL] That's why I'm sending that to you now.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] No, I, I get it because even just like trying to explain these plants to people and me trying to understand them myself, frankly, that's how I feel so I couldn't imagine.
[AGENT][NEUTRAL] Alrighty, well I did just get that sent to you. Um, you should get it here in maybe 10-15 minutes depending on how busy your machine is. Um, did you want me to go ahead and give you that claim number as well?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It'll be on the remit?
[AGENT][NEUTRAL] It will be on the ABI.
[CUSTOMER][NEUTRAL] OK, nah, I'll wait on the EOB.
[AGENT][POSITIVE] All right, sounds good. Did you have any other questions for me at the moment?
[CUSTOMER][POSITIVE] That'll be all thank you that'll be all thank you [PII].
[AGENT][POSITIVE] Alright, yes ma'am, thanks for giving us a call have a great rest of your day.
[CUSTOMER][POSITIVE] You have a good day thanks thanks you too bye bye.
[AGENT][NEUTRAL] You too bye bye.