AccountId: 011433970860
ContactId: ff8d00b0-4eb5-4f18-8d43-fc91404a157c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 229179 ms
Total Talk Time (AGENT): 71766 ms
Total Talk Time (CUSTOMER): 70176 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/ff8d00b0-4eb5-4f18-8d43-fc91404a157c_20250204T13:30_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I'm calling about a claim.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with your claim sharing. May I have a good contact number in case we're disconnected and your policy number?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] [PII] and the members policy number is 02497336.
[AGENT][NEUTRAL] OK, and [PII], you're calling from a provider's office or a group?
[CUSTOMER][NEUTRAL] Provider's office.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Uh, born Jewish.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] Birthday [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim you'd like me to take a look at?
[CUSTOMER][NEUTRAL] [PII] and the bill amount is $3,304.65.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Born Jewish Saint Peter's Hospital.
[AGENT][NEUTRAL] Here it is. OK.
[AGENT][NEUTRAL] Hold on one moment, I just located it.
[AGENT][NEUTRAL] Small received the claim on [PII].
[AGENT][NEUTRAL] That claim number is 3
[CUSTOMER][NEUTRAL] What's your first name again?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] OK, hold on.
[CUSTOMER][NEUTRAL] OK, you received it on January.
[AGENT][NEUTRAL] Mhm. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the claim number ready when you are.
[AGENT][NEUTRAL] OK, it's 354.
[AGENT][NEUTRAL] 9701.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because the calendar year max for outpatient accident and sickness treatment in the emergency room has been met.
[CUSTOMER][NEUTRAL] OK, on the [PII].
[CUSTOMER][NEUTRAL] January and.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Hari
[CUSTOMER][NEUTRAL] X E R.
[CUSTOMER][NEUTRAL] Your charges.
[CUSTOMER][NEUTRAL] So this is patient responsibility.
[AGENT][NEUTRAL] So we don't determine patient responsibility here because we're not a major medical insurance company. Um, so it would be whatever the policy is for outstanding balances.
[CUSTOMER][NEUTRAL] OK. Have you guys sent us out of the EOB?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] When, when did y'all mail it?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Any.
[CUSTOMER][POSITIVE] Oh boy
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello.