AccountId: 011433970860
ContactId: e6d9ad90-6866-463e-89ce-b73b2a03e567
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 259608 ms
Total Talk Time (AGENT): 127823 ms
Total Talk Time (CUSTOMER): 58816 ms
Interruptions: 2
Overall Sentiment: AGENT=1.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/e6d9ad90-6866-463e-89ce-b73b2a03e567_20250212T15:36_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] Hi [PII], my name is [PII]. I'm calling to check on a claim.
[AGENT][NEUTRAL] OK, I'm so sorry. There's some bad can you please repeat what you said? I wasn't able to understand you.
[CUSTOMER][NEUTRAL] Um, my name is [PII]. I'm calling to check on a claim.
[AGENT][NEUTRAL] OK, you're and you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes ma'am, I can help you with that and what is a good call back number for you please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And what is the member's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] 02362788
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII] 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] [PII] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the data service and total bill amount for her place?
[CUSTOMER][NEUTRAL] 11 7 24 in the amount of $1,785.50.
[AGENT][POSITIVE] Alright, thank you, one moment.
[AGENT][NEUTRAL] And what facility are you with?
[CUSTOMER][NEUTRAL] Deaconess Henderson Hospital.
[AGENT][POSITIVE] OK, thank you. So yes, ma'am, I do see that this claim was received.
[AGENT][NEUTRAL] And the received date.
[AGENT][NEUTRAL] For the claim is going to be [PII].
[AGENT][NEUTRAL] No, I'm sorry. Let me change that.
[AGENT][NEUTRAL] This claim was received on [PII] and processed on [PII].
[AGENT][NEUTRAL] [PII], the claim number is going to be 3531032.
[AGENT][NEUTRAL] This claim was denied and the reason for the denial En states maximum benefit for this date of service has been met.
[CUSTOMER][NEUTRAL] So is that leaving it to the patient responsibility?
[AGENT][NEUTRAL] We do not determine patient responsibility, that would be up to the provider.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then if you need a call, oh, I'm sorry, [PII], I didn't mean to speak over you.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Um, oh, no, no, you're good, um, I do have that EOB it's, um, with remark D2H0016. OK, I just wanted to verify that, yep.
[AGENT][NEUTRAL] I was gonna say
[AGENT][NEUTRAL] Oh, you did, OK.
[AGENT][NEUTRAL] Right, and the remark is.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And it should show Benefit max for this data service has been met along with that remark.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But we do have a portal in the future if you need uh an explanation of benefits or to check claim status you can go to [PII] and you should be able to check that there as well.
[CUSTOMER][POSITIVE] Great. Thank you so much. Um, can I have
[AGENT][POSITIVE] You are certainly welcome. Can I help you with anything?
[CUSTOMER][NEUTRAL] Uh, do you do reference numbers?
[AGENT][NEUTRAL] You would use my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] Great thank you I hope you have a great day.
[AGENT][POSITIVE] I hope you do too, and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Mm bye-bye.
[AGENT][NEUTRAL] Um, bye bye.