AccountId: 011433970860
ContactId: ee555bfa-783a-4811-9fc8-24f58f5eb058
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 726859 ms
Total Talk Time (AGENT): 197008 ms
Total Talk Time (CUSTOMER): 144328 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/ee555bfa-783a-4811-9fc8-24f58f5eb058_20250204T21:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good afternoon, Ms. [PII].
[AGENT][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] Hey, I have um Ms. [PII] from a provider's office with um a question about the claim status for a patient.
[AGENT][NEUTRAL] OK, all right, and um did you get [PII]'s callback number?
[CUSTOMER][NEUTRAL] No, but I wrote down the one that she's calling from that [PII].
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, alright, you can go and put her through and I'll get the information from her.
[CUSTOMER][NEUTRAL] All right. Um, I already have the policy number and verify the name and date of birth.
[CUSTOMER][NEUTRAL] If you'd like to take that.
[AGENT][NEUTRAL] OK, what's the
[AGENT][NEUTRAL] Sure, what's the policy number?
[CUSTOMER][NEUTRAL] That will be 255.
[CUSTOMER][NEUTRAL] 49.
[CUSTOMER][NEUTRAL] 30.
[AGENT][NEUTRAL] OK, alright, let me pull that up real quick and I can take her now.
[CUSTOMER][POSITIVE] All right. Thank you. Have a nice day.
[AGENT][POSITIVE] All right. Thank you. You too. You take care. Bye-bye.
[CUSTOMER][POSITIVE] Thanks.
[AGENT][NEUTRAL] Hello, [PII], this is [PII] with the care team. So I understand you need a little bit of claim information?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, I can help you with your claim, Ms. [PII]. Can I please get the name of the insured?
[CUSTOMER][NEUTRAL] This is for [PII] is the first name, his last name is spelled [PII]
[AGENT][NEUTRAL] OK, and what is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And then what is the date of service?
[CUSTOMER][NEUTRAL] Uh, his data service is going to be.
[CUSTOMER][NEUTRAL] See here. This is for [PII]. We bill $334.02.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and what is the name of the facility you're calling from, [PII]?
[CUSTOMER][NEUTRAL] CH University Medical Group.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I pull in this claim for you and I'll be right back.
[CUSTOMER][NEUTRAL] All right, thank you. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] That ain't it.
[AGENT][NEUTRAL] 353.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi [PII], this is [PII] back with you again. So I did find the claim and the claim was paid $75 with check number 2018583.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And there are some remarks on the claim, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] The vana puncture is not covered by the policy.
[AGENT][NEUTRAL] And then the maximum amount for that date of service was met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, the max was Smith.
[AGENT][NEGATIVE] And it also doesn't cover, yes, and it also doesn't cover um vaccines and immunizations.
[CUSTOMER][NEUTRAL] Vaccines and immunization.
[CUSTOMER][NEUTRAL] All right. I have one more patient. Can you take a look at that one?
[AGENT][POSITIVE] Yes, ma'am, and I did want to let you know that that check did clear.
[AGENT][NEUTRAL] That was sent um it cleared on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, thank you.
[AGENT][NEUTRAL] OK. And what was the next patient's name?
[AGENT][NEUTRAL] Or is it for the same one?
[CUSTOMER][NEUTRAL] Uh, the next patient.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, it's a different patient.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, let's see here.
[CUSTOMER][NEUTRAL] This is for, patient is [PII].
[AGENT][NEUTRAL] OK. And what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And his policy number?
[CUSTOMER][NEUTRAL] Don't have the policy number. Uh, what I have, it starts with a D43731105. I know usually after they received it they'll forward it to uh.
[AGENT][NEUTRAL] 90 degree benefits. Yeah.
[CUSTOMER][NEUTRAL] You guys for American public for pro.
[AGENT][NEUTRAL] OK, alright, um, do you have [PII]'s social security number? I can pull it in that way.
[CUSTOMER][NEUTRAL] Oh, let's see here.
[CUSTOMER][NEUTRAL] Uh, let's see if I have that one.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and what was the 1st 3 digits again, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, let me look.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and is this gonna be for his hospital indemnity plan? He's got
[AGENT][NEUTRAL] Is it a medical claim?
[CUSTOMER][NEUTRAL] Medical client.
[AGENT][POSITIVE] OK. OK, thank you.
[AGENT][NEUTRAL] Alright, I think I have it pulled up now. What is the data service for [PII]?
[CUSTOMER][NEUTRAL] [PII], we billed $17.
[AGENT][NEUTRAL] OK and then is it for the same facility?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, alright, I'm gonna put you on hold again so I can pull up [PII]'s I'll be right back with you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi [PII], this is [PII] back again. So I did find the claim. The claim number is 3,551,670.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] The claim was received on
[AGENT][NEUTRAL] [PII] and it was processed on [PII]. The claim is pending eligibility.
[AGENT][NEUTRAL] But I will let you know that the policy did lapse on [PII].
[CUSTOMER][NEUTRAL] OK, and you don't show any coverage after that date?
[AGENT][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] I mean, well, OK, mhm.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] Alright then I would just make this patient's responsibility coverage termed on [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] All right. Thank you. Reference number for our call.
[AGENT][NEUTRAL] Yes, ma'am. You can use my name. It is [PII] in today's date.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][POSITIVE] Thank you, [PII]. Have a good day. Bye-bye.
[AGENT][POSITIVE] You're very welcome. You have a blessed one. Thanks, [PII], for calling APL. Bye bye.