AccountId: 011433970860
ContactId: f80fe3fb-c3ad-4691-9856-8b2f7c17888c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 285299 ms
Total Talk Time (AGENT): 94027 ms
Total Talk Time (CUSTOMER): 97520 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/f80fe3fb-c3ad-4691-9856-8b2f7c17888c_20250317T16:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, I'm calling on claim 3573829.
[AGENT][NEUTRAL] OK, I can help you with your claim. Can I please get your name and your policy number?
[CUSTOMER][NEUTRAL] Policy number.
[CUSTOMER][NEUTRAL] 2,138,760
[AGENT][NEUTRAL] OK, and then what is your name?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I'm the secretary to doctor.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] The father of the patient, [PII].
[CUSTOMER][NEUTRAL] So, he got a
[AGENT][POSITIVE] OK, thank you, Miss [PII].
[CUSTOMER][NEGATIVE] He got an EOB. It says they're not gonna pay benefits on this.
[CUSTOMER][NEGATIVE] But uh it, apparently didn't, you didn't understand that it was inpatient service.
[CUSTOMER][NEUTRAL] She, she was, she had
[AGENT][NEUTRAL] OK, so you're calling.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] I'm sorry, I didn't hear what you're saying.
[AGENT][NEUTRAL] So you're calling about [PII]. This claim is for [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, alright, let me look this claim up for you and give you some answers.
[CUSTOMER][POSITIVE] Sure. Thank you.
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] OK, what's the name of the facility?
[CUSTOMER][NEUTRAL] Saint Mary's Medical Center.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so, um, the claim was denied because we need the itemized statement, um, with the diagnosis and procedure codes.
[AGENT][NEUTRAL] And the explanation of benefits from the major medical insurer.
[CUSTOMER][NEUTRAL] Um, OK. Apparently he just got this one explanation of benefits as it was.
[CUSTOMER][NEUTRAL] 0 paid. So, so what does he need now to send in?
[AGENT][NEUTRAL] He needs he needs the itemized statement with the diagnosis and procedure codes.
[AGENT][NEUTRAL] And explanation of benefits from the medical.
[CUSTOMER][NEUTRAL] Wait a minute. I know.
[CUSTOMER][NEUTRAL] Procedure, diagnosis, and procedure codes.
[CUSTOMER][NEUTRAL] And, and the third thing?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, the explanation.
[CUSTOMER][NEUTRAL] What else did you say? I'm sorry.
[AGENT][NEUTRAL] The explanation of benefits from the major medical insurance. Both of those forms need to be sent in.
[CUSTOMER][NEUTRAL] OK, he needs, I think he, the itemized statement that we sent initially.
[CUSTOMER][NEUTRAL] It showed like $160,000 of uh expenses. Do you see that there?
[AGENT][NEUTRAL] No, I can't see the paperwork. I I can only verify how the is processed and the claim examiner being the the itemized.
[AGENT][NEUTRAL] With diagnosis procedure codes and they also need the explanation it's the major medical insurance.
[CUSTOMER][NEUTRAL] OK. All right.
[CUSTOMER][POSITIVE] OK, I guess we'll have to get after that. Thank you very much.
[AGENT][POSITIVE] OK, well, you're so welcome. Is there anything else that I can help you with Ms. [PII], before we go?
[CUSTOMER][NEUTRAL] Um, no, not today. Thanks anyway.
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] You're welcome you have a great day and thank you for calling APL.
[CUSTOMER][POSITIVE] OK. Thank you very much. Bye-bye.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] But I