AccountId: 011433970860
ContactId: ed342e3e-68a8-4cb5-b2ab-798f0518b003
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 392630 ms
Total Talk Time (AGENT): 108039 ms
Total Talk Time (CUSTOMER): 122048 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/ed342e3e-68a8-4cb5-b2ab-798f0518b003_20250110T15:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, good morning. My name is [PII] and I'm calling on behalf of Jenny Stewart Medical Center. I do wanna let you know that my call is being recorded and monitored for quality assurance and training purposes. Is that OK?
[AGENT][NEUTRAL] Yes ma'am, that's fine.
[CUSTOMER][NEUTRAL] OK, perfect. I have an EOB here um and it doesn't have anything anywhere, so I just had a couple questions for you about the claim.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, Ms. [PII], I can help you with the claim. Can you please give me your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] OK, my number is [PII] and that is my direct line.
[AGENT][NEUTRAL] OK, thank you. And then what is the patient's name?
[CUSTOMER][NEUTRAL] The patient's name is [PII].
[AGENT][NEUTRAL] And what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII]. I'm not sure if it's under just [PII] or just [PII] or it could be under both. Um, her, the, the date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then what is her policy number, please?
[CUSTOMER][NEUTRAL] The policy number is 02497110.
[AGENT][NEUTRAL] OK, let me pull in that policy for us real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, we have her as [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Make note of that.
[AGENT][NEUTRAL] OK. And what is the claim number, please?
[CUSTOMER][NEUTRAL] Um, I do not have the claim number. There's, it's just a blank EOB, which is why I'm calling.
[AGENT][NEUTRAL] Oh my. Oh my. OK. What is
[CUSTOMER][NEUTRAL] It, um, it doesn't have a claim number or check number is, and it just says 0 everywhere, so.
[AGENT][NEUTRAL] Oh my goodness gracious. Looks like you got um one that should have been tossed in the trash.
[AGENT][NEUTRAL] What was the um data service for [PII]?
[CUSTOMER][NEUTRAL] Data service is 9-12-2024.
[AGENT][NEUTRAL] OK and then what was the charge amount?
[CUSTOMER][NEUTRAL] $1,001.55.
[AGENT][NEUTRAL] OK, alright, let me see if I can't find the claim.
[AGENT][NEUTRAL] And see if there's any remarks on it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I found it.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] And let's see what's going on with it.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] The claim number is 353.
[AGENT][NEUTRAL] 4702.
[AGENT][NEUTRAL] And the claim was denied because the calendar year maximum for outpatient accident and sickness treatment in the ER has been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh perfect.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think that is all that I need. Um, is there any way that you can fax that over to me? Let me see.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] Yeah, that way we can go ahead and put it in here and um no one's looking for it later. They're gonna be like, what is this blank thing?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes ma'am, what is your fax number?
[CUSTOMER][NEUTRAL] Um, the same as the number is [PII].
[AGENT][NEUTRAL] OK, I'm gonna put you on hold. I'm gonna fax that while we're on the phone together, so it's gonna be a brief hold while I get that done for you and I'll be right back.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK, not a problem thank you so. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi [PII], this is [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] That fax is on its way to you.
[CUSTOMER][POSITIVE] Perfect. Thank you so much, [PII]. You have a great day and happy [PII].
[AGENT][POSITIVE] You're so very welcome. [PII] to you too. I hope you have a wonderful weekend. It's here, yay.
[CUSTOMER][POSITIVE] You as well. Yes, thank you. I definitely needed that reminder.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] You have a good one.
[AGENT][POSITIVE] You too, thanks for calling APL bye bye.
[CUSTOMER][NEUTRAL] Bye bye.