AccountId: 011433970860
ContactId: e97925aa-3a45-4df5-979a-73251c638ca5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 641880 ms
Total Talk Time (AGENT): 175647 ms
Total Talk Time (CUSTOMER): 106258 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/e97925aa-3a45-4df5-979a-73251c638ca5_20250211T17:03_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for calling APL. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling to check for a claim and clarification today.
[AGENT][NEUTRAL] OK [PII], I can help you with claim um can I please get your callback number sir just in case our call is disconnected?
[CUSTOMER][NEUTRAL] [PII]. That's with the extension [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what is the uh patient's name?
[CUSTOMER][NEUTRAL] Patient's first name is [PII], last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And what is the patient's policy number, sir?
[CUSTOMER][NEUTRAL] Policy number of the patient is 022854771.
[AGENT][NEUTRAL] OK, let me look that up.
[AGENT][NEUTRAL] OK and then what is the date of service?
[CUSTOMER][NEUTRAL] [PII] and uh do you want the claim number?
[AGENT][NEUTRAL] Um, can you give me the, um, charge amount for that date of service, please?
[CUSTOMER][NEUTRAL] Yeah, of course that is $1,312 even.
[AGENT][NEUTRAL] OK, thank you. And then what is the claim number?
[CUSTOMER][NEUTRAL] That is 3305582.
[AGENT][NEUTRAL] OK and then what is the name of the facility you're calling for, sir?
[CUSTOMER][NEUTRAL] Prishma Health University Medical Group.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up this claim, [PII] and I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, [PII], I've got the claim pulled up and the remarks on the claim.
[AGENT][NEUTRAL] Is that anesthesia benefits are based on the benefits allowable under the surgery benefit. Please send the surgery charges for this date so that both benefits can be considered.
[AGENT][NEUTRAL] So we're needing the surgery charges.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] So, actually, uh, previously, I spoke with uh [PII].
[CUSTOMER][NEUTRAL] Uh, just 10 minutes ago, the call was disconnected actually. So that's the reason why I'm calling back. So she verified that you guys have received the medical records. So we have already submitted them on [PII]. Could you please check for them?
[AGENT][NEUTRAL] OK, let me check.
[AGENT][NEUTRAL] And what was the date again, please, sir?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, let me look.
[AGENT][NEUTRAL] And you were actually speaking with somebody in the claims department, is that correct?
[CUSTOMER][NEUTRAL] Yeah, the call was disconnected. I
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] And we are speaking.
[AGENT][NEUTRAL] OK transfer you back over to the claims department so you could speak with somebody there um since you were disconnected, we wanna make sure that you get the help that you need so it's gonna be a brief hold while I transfer you on over to the claims department so that they can further assist you.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] So this is not the claims department?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] But I'm gonna get you there, so it's gonna be a brief hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[AGENT][NEUTRAL] Well, hey, [PII], this is [PII].
[CUSTOMER][NEUTRAL] Hey, [PII], what?
[AGENT][NEUTRAL] Hey, I was trying to transfer a provider back over to claims because he got the call was dropped, so he was calling back about his claim and obviously they're not answering so I'm gonna go ahead and get his name and number and do a hub request for somebody to call him.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK. Thanks, [PII].
[CUSTOMER][POSITIVE] All right. You're welcome. Bye-bye.
[AGENT][NEUTRAL] All right, bye bye.
[AGENT][NEUTRAL] Hi [PII].
[AGENT][NEUTRAL] Hi [PII], this is [PII] um with APL so there isn't anybody in the in the claims department that can help you at the moment so what I'm gonna do is I'm gonna get your number. I'm gonna verify your number again and as soon as somebody is available they will return your call um so the number you gave me was [PII].
[AGENT][NEUTRAL] [PII], is that correct? OK, well I'm gonna make sure that somebody gives you a call back. I'm gonna put you on a hold while I put that request in for you that way you can get your assistance. It's gonna be a brief hold.
[CUSTOMER][POSITIVE] Yeah, that's right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Hi [PII], I've got that request and then you should be getting a return call so that you can get assistance with your claim.
[AGENT][NEUTRAL] You there?
[CUSTOMER][NEUTRAL] Yeah, uh, could you able to hear me?
[AGENT][NEUTRAL] Yes I can hear you. I just wanna let you know I've got that um request in for somebody to return your call so you can have assistance with your claim.
[CUSTOMER][POSITIVE] Yeah, sure. Uh, got it. And thank you for providing your assistance today. You have a great day.
[AGENT][POSITIVE] You too [PII] thank you you have a blessed one thanks for calling APL.
[AGENT][NEUTRAL] Bye-bye, sir.