AccountId: 011433970860
ContactId: 09f20989-7ac9-402a-ad8c-5be98328c247
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 592729 ms
Total Talk Time (AGENT): 214208 ms
Total Talk Time (CUSTOMER): 145357 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/09f20989-7ac9-402a-ad8c-5be98328c247_20250213T16:15_UTC.wav
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[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, this is [PII]. I'm calling from the business office of Brookwood Medical Center, and I'm checking for a claim status, and I just wanted this call is being monitored and recorded for quality and training purposes.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status. And just for my notes, can you spell your first name for me, please?
[CUSTOMER][NEUTRAL] [PII] spelled [PII]
[AGENT][NEUTRAL] And [PII], may I have a good contact number in case we're disconnected and then the policy number?
[CUSTOMER][NEUTRAL] [PII], no extension.
[CUSTOMER][NEUTRAL] And number ID [PII].
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Bye
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth is [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 want me to check on?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] 40 $4,375 even.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Brookwood Medical Center.
[AGENT][NEUTRAL] Alright, so I'm showing that the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 3558635.
[AGENT][NEGATIVE] And on [PII], the claim was also denied, um, and hold on one moment, I'm getting the denial reason.
[AGENT][NEUTRAL] Um, OK, so it says we're unable to assign benefits to the provider of record due to a discrepancy with the provider's tax ID number?
[AGENT][NEUTRAL] A letter has been mailed to the provider with instructions on resolving the discrepancy.
[AGENT][NEUTRAL] The provider will need to resolve the discrepancy with our office to resume receiving communications regarding claims and benefits payments.
[AGENT][NEUTRAL] Our claim decision including any payable benefits for this um charge has been sent to the insured.
[CUSTOMER][NEUTRAL] Um, just for, um, accident information I did for this.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Um, it's just, um.
[CUSTOMER][NEUTRAL] Need accident information.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] What I just read to you was the denial reason for the claim. This is until the tax document, uh, the tax ID is the discrepancy is corrected, we won't be able to process this claim.
[CUSTOMER][NEUTRAL] One moment, let me check this one.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One moment checking for this one.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Yeah, I'm so confused. What do you mean, uh, providers, uh, dis discrepancy with the provider's tax ID?
[AGENT][NEUTRAL] What I'll do is, um, if you hold on just a moment, I'll reach out to a claims examiner so that they can um go over this with you more in detail because they're the uh department that examined the claim and they, they can go more in detail of what this means.
[AGENT][NEUTRAL] In terms of the claim and the tax ID being um corrected.
[CUSTOMER][NEUTRAL] See see.
[AGENT][NEUTRAL] All right, before I reach out to the claims department, was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Uh, so do we need to allow more time for you to, um, clarify more information about this claim.
[AGENT][NEUTRAL] I'm going to call a claims representative on the other line, and then I'm gonna connect you two together for the claims examiner to explain their claims decision to you.
[CUSTOMER][NEUTRAL] I don't
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, can you provide the reference number?
[AGENT][NEUTRAL] All right, um,
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date, and that's [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] The most of the.
[AGENT][NEUTRAL] Alright, and hold on one moment for your transfer.
[CUSTOMER][NEUTRAL] It's like.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright and thanks for calling APO. Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] No, I gotta go back. Let me try.
[AGENT][NEUTRAL] H I
[AGENT][NEUTRAL] Oh, I don't think we can call each other anymore, right?
[AGENT][NEUTRAL] Oh Lord. What, what was the um thing?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] God.
[AGENT][NEUTRAL] Oh my God. OK. All right.
[AGENT][NEUTRAL] Yes, OK.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you so much for holding. I do apologize for the wait. Um, I wasn't able to get anyone in the hospital indemnity um claims line. So I'll go ahead and send them over a message and have them give you a call with an update on this denial reason and speak with you further about it. Is there a good contact number or an extension to this contact number so that they can reach you?
[CUSTOMER][NEGATIVE] No extension.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, within today they will call, call us back.
[AGENT][NEUTRAL] Yes, we say within 24 to 48 hours at the most.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][POSITIVE] Yeah, I understand. uh, by the way, [PII], um, we will wait until we, uh, receive the call, um, call back. So by the way, thank you so much for your assistance.
[AGENT][NEUTRAL] You're very welcome. And just to confirm, the phone number is [PII]?
[CUSTOMER][POSITIVE] Yes, you're correct.
[AGENT][NEUTRAL] OK, so I'll go ahead and send this over to them now. I'll send it to them urgent so that they can give you a call and um help you with the denial reason.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] What?
[CUSTOMER][NEUTRAL] Is that uh um uh claims department?
[AGENT][NEUTRAL] Yes, the claims examiner will be giving you a call back.
[CUSTOMER][NEUTRAL] Oh, claims examiner.
[CUSTOMER][NEUTRAL] OK, and you are for a claims department, correct representative.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] No, this is not claims. This is customer care. I'm getting you, I'm putting you with claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I got it. By the way, thank you so much for your assistance. Bye for now.
[AGENT][POSITIVE] You're very welcome and thanks for calling APL. I hope you have a good day.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye bye.