AccountId: 011433970860
ContactId: f0b27484-db7f-48b5-b487-b70be5c3df8f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 584630 ms
Total Talk Time (AGENT): 162954 ms
Total Talk Time (CUSTOMER): 119920 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/2025/01/08/f0b27484-db7f-48b5-b487-b70be5c3df8f_20250108T15:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling to um check status of a claim, please.
[AGENT][NEUTRAL] OK, I can help you with claim status. What is your name, please?
[CUSTOMER][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] What is this?
[AGENT][NEUTRAL] OK [PII], what is your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. And then what is the, OK, thank you so much for letting me know that. And what is the patient's name?
[CUSTOMER][NEUTRAL] And it's the direct.
[CUSTOMER][NEUTRAL] [PII], date of birth [PII].
[AGENT][NEUTRAL] OK, and then what is [PII]'s policy number?
[CUSTOMER][NEUTRAL] D as in Delta 46401428
[AGENT][NEUTRAL] OK, and you spell his last name [PII]?
[CUSTOMER][POSITIVE] [PII], yes.
[AGENT][NEUTRAL] OK, and the first name is [PII]?
[CUSTOMER][NEUTRAL] I see, OK.
[AGENT][NEUTRAL] OK, let me see if I can pull him up by his name real quick.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have another number in here as well.
[AGENT][NEUTRAL] What's the number that you have?
[AGENT][NEUTRAL] A
[CUSTOMER][NEUTRAL] I have a [PII]. I just got off the phone with APL and they transferred me. No, I just got off the phone with IMA and they transferred me over here saying that the claim was was sent over there on [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Let me look him up. That 2nd number is the magic number. That's the one that pulled it in for me, OK, and what was the date of service for him?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Um, [PII] and the full bill amount is.
[CUSTOMER][NEUTRAL] 13,567 and 90 cents.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Um Wellstar C Hospital.
[AGENT][NEUTRAL] OK, I am going to put you on a brief hold, Miss [PII], while I look up this claim for you and I'll be right back.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi Miss. [PII], this is [PII] back again.
[AGENT][NEUTRAL] In with you so I did find the claim and the claim number is 354.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 623 2.
[AGENT][NEUTRAL] And it has marks on it. One is the outpatient rider only allows payment for outpatient surgery in an outpatient hospital or physician's office.
[AGENT][NEUTRAL] Before no benefits are payable.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then on the imaging, the benefit maximum for this state of service has been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, is there a way that I can get a set up a claim number? When did it deny?
[AGENT][NEUTRAL] Uh, on the surgery, it denied because the outpatient rider only allows payment for.
[AGENT][NEUTRAL] Surgery in an outpatient hospital or physician's office and then on the imaging, the benefit maximum for this data service was met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, what date did the claim process?
[AGENT][NEUTRAL] Let me look for you.
[AGENT][NEUTRAL] We received it.
[AGENT][NEUTRAL] On let's see.
[AGENT][NEUTRAL] OK, we received it on.
[AGENT][NEUTRAL] [PII] and we processed it on [PII].
[CUSTOMER][NEUTRAL] OK, is there any way that you can, uh, email, fax me an EOB, or did you, did you already send it out?
[AGENT][NEUTRAL] No ma'am it's already been sent but I can fax can you please give me your fax number?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yes, one second, let me, um, pull it up. I know it's um [PII] 770.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, can you give me the first three digits again, please?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, Miss [PII], I'm gonna put you on a brief hold while I get that faxed over to you while we're on the phone together.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi Miss [PII], this is [PII] back with.
[AGENT][NEUTRAL] You again, I do have that fax on its way to you.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] You awesome, awesome sauce. Thank you so much, [PII].
[AGENT][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] You're welcome, Ms. [PII].
[CUSTOMER][NEUTRAL] Is there a reference number or is it your name?
[AGENT][NEUTRAL] Yes, you can use my name and today's date.
[CUSTOMER][POSITIVE] You thank you so much. I hope you have a great day.
[AGENT][POSITIVE] You too, Ms. [PII]. Thank you for calling APL.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Mhm bye bye.