AccountId: 011433970860
ContactId: 0042b431-f4f4-405b-9390-b3494f63da47
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 743849 ms
Total Talk Time (AGENT): 204174 ms
Total Talk Time (CUSTOMER): 150873 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/0042b431-f4f4-405b-9390-b3494f63da47_20250204T20:56_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] I'm calling from provider office to check my status.
[AGENT][NEUTRAL] OK, I can help you with claim status. Can I please get your name?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK [PII], what is your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] Thank you. And then what is the patient's name?
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, and then what is [PII]'s policy number, please?
[CUSTOMER][NEUTRAL] Oh, it's 02496781.
[AGENT][NEUTRAL] OK, let me look that up.
[AGENT][NEUTRAL] OK, and then what is the day the service?
[CUSTOMER][NEUTRAL] Oh, it's [PII] with the bill amount of $490.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEGATIVE] Uh, payment was denied for this one.
[AGENT][NEUTRAL] Oh OK alright and then what's the name of the facility you're calling for?
[CUSTOMER][NEUTRAL] It's Holy Cross Medical Group.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up this claim for you, Miss [PII], and I'll be right back.
[CUSTOMER][POSITIVE] Yeah, sure, take your time.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII], this is [PII]. I've got the claim ready for you.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] The claim number is.
[CUSTOMER][NEUTRAL] Uh, OK.
[AGENT][NEUTRAL] The claim number is 354.
[AGENT][NEUTRAL] 2952.
[AGENT][NEUTRAL] The claim was received on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The claim was denied and let me read you the reason why.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Pull it up again real quick.
[AGENT][NEUTRAL] The benefits are payable only if your major medical insurance provider provides benefits. If this claim is later paid by your major medical clearance, please send the explanation of benefits showing benefits were paid.
[CUSTOMER][NEUTRAL] Oh, I so.
[CUSTOMER][NEGATIVE] Timely denials, so the second is not paid for this one.
[AGENT][NEUTRAL] Right, so if the major medical denied, then we're gonna deny also because we will only pay if the major medical pays.
[CUSTOMER][NEUTRAL] Oh, like
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] May I know what is the exact deline on this one?
[AGENT][NEUTRAL] The exact denial is, let me give you the number D as in dog 2.
[AGENT][NEUTRAL] M as in Michael.
[AGENT][NEUTRAL] 37
[AGENT][NEUTRAL] And it says benefits.
[AGENT][NEUTRAL] are payable only if your major medical insurance provider provides benefits.
[AGENT][NEUTRAL] If this claim is later paid by your explanation of benefits showing benefits were paid.
[CUSTOMER][NEUTRAL] Uh, like it means, like, uh, primary insurance pays the secondary will process the claim.
[AGENT][NEUTRAL] We're the secondary insurance, so we'll need the EOB from the major medical insurance in order to be able to process the claim.
[CUSTOMER][NEUTRAL] OK. It's not even you will be denying, right?
[AGENT][NEUTRAL] Where the major but it has.
[AGENT][NEUTRAL] Right, we'll have to have the EOB with the major medical paid.
[CUSTOMER][NEUTRAL] Um, can you adjust of my it's package.
[AGENT][NEUTRAL] And that needs to be sent to us.
[CUSTOMER][NEUTRAL] OK, um, and for this one.
[CUSTOMER][NEUTRAL] Last time when we called on [PII].
[CUSTOMER][NEUTRAL] What do you mean?
[CUSTOMER][NEUTRAL] On [PII], the stated that it is denied for COB information from the patient.
[AGENT][NEUTRAL] Well, it, it's been processed and.
[AGENT][NEUTRAL] We need
[AGENT][NEUTRAL] The explanation of benefits showing the major medical insurance paid.
[CUSTOMER][NEUTRAL] Uh, is it not for COP update?
[AGENT][NEUTRAL] I'm sorry, I don't understand what you're saying.
[CUSTOMER][NEUTRAL] Uh, last name and we called that stated that it is denied for coordination of benefit to be updated from the patient.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No, it's because the major medical insurance needs to pay, and we need the explanation of benefits showing that they were it was paid from the major medical.
[CUSTOMER][NEUTRAL] OK. And uh can you also fax me this EOB copy?
[AGENT][POSITIVE] Yeah, absolutely. What is your fax number?
[CUSTOMER][NEUTRAL] Oh, it's [PII].
[AGENT][NEUTRAL] OK, I'm gonna put you on hold while I get that taken care of for you. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you [PII] for holding for me. I do have that fax on its way to you now.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] OK, um, may I know when we receive that one?
[AGENT][NEUTRAL] You gotta give it a chance to come through the fax line. It's been sent.
[CUSTOMER][NEUTRAL] OK, thank you for that and also know when was this members coordination of benefit was updated?
[AGENT][NEUTRAL] We do the coordination of benefits. It's done by the policy.
[AGENT][NEUTRAL] And how the policy is written in the in the patient's policy.
[CUSTOMER][NEUTRAL] Oh, may I know
[CUSTOMER][NEUTRAL] Oh, is there any date for that?
[AGENT][NEUTRAL] No, the policy effective date.
[AGENT][NEUTRAL] Is [PII].
[CUSTOMER][POSITIVE] OK, thank you so much for that.
[CUSTOMER][NEUTRAL] And I also didn't catch up your name. Can you spell it for me?
[AGENT][NEUTRAL] I'm sorry, what did you just say? Can you repeat that?
[CUSTOMER][NEUTRAL] I, uh, uh, can you spell out your name for me?
[AGENT][NEUTRAL] Yes, ma'am. It's [PII]
[CUSTOMER][NEUTRAL] And may I have your last name initial?
[AGENT][NEUTRAL] A
[CUSTOMER][POSITIVE] Yeah, OK, thank you so much for that and also have the call first of phone call.
[AGENT][NEUTRAL] Yes, ma'am, you can use my name and today's date.
[CUSTOMER][POSITIVE] OK, thank you so much for asking and have a wonderful day.
[AGENT][POSITIVE] You too, Ms. [PII], you have a blessed one. Thanks for calling APL.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][POSITIVE] You. Goodbye. Take care.