AccountId: 011433970860
ContactId: 0e138211-f279-4e54-8147-90657d0da0c8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2059320 ms
Total Talk Time (AGENT): 483729 ms
Total Talk Time (CUSTOMER): 384497 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/0e138211-f279-4e54-8147-90657d0da0c8_20250331T20:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling you from Mercy Hospital. I'm calling you an information a claim. And you said your name was, can you please spell it for me? I'm sorry, I didn't catch that.
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] OK, sorry.
[AGENT][NEUTRAL] OK, and [PII], what is your callback number just in case our call gets disconnected?
[CUSTOMER][NEUTRAL] Yes, our callback number [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what's the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yeah, one moment please I'm just pulling it up here.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] OK. Take your time.
[CUSTOMER][POSITIVE] Yeah thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Uh, 735 0 yeah, so that member ID number 02006138.
[CUSTOMER][NEUTRAL] Member named [PII].
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][NEUTRAL] OK, let me pull up that policy real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me make sure I've got it correct. 020061381?
[CUSTOMER][NEUTRAL] 02006138, not 381 6138.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Oh, OK, thank you. I appreciate you helping me with that.
[AGENT][NEUTRAL] OK, and what is, and you said the
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The member's name was [PII].
[AGENT][NEUTRAL] None. OK.
[CUSTOMER][POSITIVE] Yes [PII], yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so looking on policy number 02006138.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] I don't find a member, it's, that's the right policy number, but it's for a different member.
[CUSTOMER][NEUTRAL] Uh, OK, one moment please.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Yeah, that's correct number. So can you please verify with their social security number?
[AGENT][POSITIVE] Yes, please. That would work. Yes, sir.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, so for [PII], that's social security number [PII].
[AGENT][NEUTRAL] OK, let me look up this policy like that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Give me just a moment while the computer is searching.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so looking under.
[AGENT][NEUTRAL] Social [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yeah, it's not pulling anybody up for me with that name.
[AGENT][NEUTRAL] Do you have the claim number?
[CUSTOMER][NEUTRAL] But that
[CUSTOMER][NEUTRAL] No, we haven't received any information.
[AGENT][NEUTRAL] OK, so this member is not in our system.
[CUSTOMER][NEUTRAL] It's not in our system.
[AGENT][NEUTRAL] Can you, let me try one more thing. Let's try by his name. Can you spell the last name for me?
[CUSTOMER][NEUTRAL] Yes, the last name [PII].
[AGENT][NEUTRAL] OK, let's try that way.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I think I may have found him.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me give you that policy number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's 2006.
[AGENT][NEUTRAL] 183.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 300.
[AGENT][NEUTRAL] 2006.
[CUSTOMER][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] 183. The 3 and the 8 on your side is backwards.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Now,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Can you please give me the date of service?
[CUSTOMER][NEUTRAL] Yeah, date of service uh [PII].
[AGENT][NEUTRAL] Came with the charge amount?
[CUSTOMER][NEUTRAL] Charge amount $263 even.
[AGENT][NEUTRAL] 63
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and then what's the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] $30. Yes, yes, $30.
[AGENT][NEUTRAL] 30.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you're calling from Mercy Hospital, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up this claim and I'll be right back.
[CUSTOMER][POSITIVE] Yeah, thank you.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, [PII], this is [PII] back with you again. So looking, looking on data service of [PII], I do have a claim on file for your facility, but the amounts are different than the amounts that you gave me.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me just note it down.
[CUSTOMER][NEUTRAL] OK. Uh, what is this members effective and term date?
[AGENT][NEUTRAL] The effective date is
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And there's no term date, the policy is still active.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so may I have that mailing address to resubmit this claim?
[AGENT][NEUTRAL] Yes, sir. It's [PII].
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] One moment, please. 7.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Attention to
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Are you there?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hi I can hear you.
[CUSTOMER][NEUTRAL] Yes, yes, I'm
[CUSTOMER][NEUTRAL] Yeah, uh, what is that a timely filing one?
[AGENT][NEUTRAL] We don't have one.
[CUSTOMER][NEUTRAL] Oh OK and call reference number?
[AGENT][NEUTRAL] You can use my name [PII] in today's date.
[CUSTOMER][NEUTRAL] OK sorry sorry I have a few more claims in here can you please help?
[AGENT][NEUTRAL] Yes sir, can you give me the next members is it for the same member or is it for different ones?
[CUSTOMER][NEUTRAL] A different member
[AGENT][NEUTRAL] OK, what's the next member's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yes, one moment, please. I'm just pulling it up here.
[AGENT][POSITIVE] OK, go ahead, take your time. Yes, sir.
[CUSTOMER][POSITIVE] Very quickly.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The next member ID number 018.
[CUSTOMER][NEUTRAL] 28776.
[AGENT][NEUTRAL] OK, and what's the member's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, [PII] date of birth [PII].
[AGENT][NEUTRAL] OK, let me look up that policy number.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and then what is the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Uh, yeah, [PII], charged amount, $3,0094.81.
[AGENT][NEUTRAL] OK, and then what's the amount after the primary paid their part?
[CUSTOMER][NEUTRAL] $300.
[AGENT][NEUTRAL] OK, and is this for Mercy Hospital also?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, alright please hold again while I look up this claim and I'll be right back.
[CUSTOMER][POSITIVE] Yeah, sure, take your time.
[AGENT][NEUTRAL] That you
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, [PII], thank you very much for holding for me. So I found the claim. The claim number is 3565. Yes, sir.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One moment sorry.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Yeah 356 5.
[AGENT][NEUTRAL] 067.
[AGENT][NEUTRAL] And the benefit went towards the patient's $1000 deductible.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] When was the claim received and processed?
[AGENT][NEUTRAL] OK, let me look.
[AGENT][NEUTRAL] We received it on [PII] and processed it on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And denied OK and, and process that um uh $300 towards member responsibility, right?
[AGENT][NEUTRAL] Towards their deductible.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] 300.
[CUSTOMER][NEUTRAL] To war.
[CUSTOMER][NEUTRAL] The deductible.
[CUSTOMER][NEUTRAL] OK. Do you have that UB? Could you please fax us?
[AGENT][NEUTRAL] Yes, I can. Can I get your fax number?
[CUSTOMER][NEUTRAL] Yeah, fax number [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and how do I spell your name?
[CUSTOMER][NEUTRAL] Oh, my name is [PII]. That's spelled [PII].
[AGENT][POSITIVE] Oh, I had it right. I spelled it right on my paper. OK, it's gonna be a brief hold. I'm gonna, I'm gonna get that faxed right over to you. I'm gonna get it ready and I'll be right back. Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sure. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Come on computer.
[AGENT][NEUTRAL] Come on.
[AGENT][NEUTRAL] OK, [PII], I have that on its way to you now.
[CUSTOMER][NEUTRAL] Yeah, thank you, [PII] and uh shall I give that next next member ID number?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, so that next member ID number.
[CUSTOMER][NEUTRAL] 018.
[CUSTOMER][NEUTRAL] 287
[CUSTOMER][NEUTRAL] 64
[AGENT][NEUTRAL] OK, 0128764. Is that correct?
[CUSTOMER][NEUTRAL] 018.
[CUSTOMER][NEUTRAL] 28764.
[AGENT][NEUTRAL] OK, let me repeat it. 01828764.
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, and what's the member's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, um, [PII] [PII].
[AGENT][NEUTRAL] OK, let me pull up that policy real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK and then what is the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Yeah, so
[CUSTOMER][NEUTRAL] The date of service, um, this claim.
[CUSTOMER][NEUTRAL] Uh, how much is that?
[CUSTOMER][NEUTRAL] OK, yeah, date, uh, date of service [PII] and that amount bill at $245.75.
[AGENT][NEUTRAL] OK, and then what is the amount after the primary?
[CUSTOMER][NEUTRAL] $50.
[AGENT][NEUTRAL] OK, and same facility, [PII]?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] Uh, OK, brief hold again. I'm gonna look up this claim. I'll be right back.
[CUSTOMER][NEUTRAL] Sure. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me. So I have [PII]'s claim, um, the claim number is.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 356.
[AGENT][NEUTRAL] 5076. The claim was received on [PII].
[AGENT][NEUTRAL] And processed on [PII].
[AGENT][NEUTRAL] And it's the same situation, the $50 went towards the patient's deductible.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm, OK, $50.
[CUSTOMER][NEUTRAL] OK, may I have um.
[CUSTOMER][NEUTRAL] What is that?
[CUSTOMER][NEUTRAL] That you will be
[AGENT][NEUTRAL] Yes, I'm gonna put you on hold again, send it to the same fax number.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][POSITIVE] OK, brief hold I'm gonna get it ready for you.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me that fax is on its way to you now.
[CUSTOMER][POSITIVE] Yeah, OK. Thank you so very much and I have the next claim here for you.
[AGENT][NEUTRAL] OK. And what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yes, uh, policy number 01897890.
[AGENT][NEUTRAL] OK, our phone cut out for a minute. Can you give me that policy number again?
[CUSTOMER][NEUTRAL] Oh yeah. 01897890.
[AGENT][NEUTRAL] OK, and the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, their name is [PII].
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then what is the um
[AGENT][NEUTRAL] Let me look that up real quick. Let me look up.
[CUSTOMER][NEUTRAL] Date of service yeah.
[AGENT][NEUTRAL] Yeah, we'll look up the policy first.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] OK, and then what is the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Date of service [PII]. A amount $3,609.22.
[AGENT][NEUTRAL] OK, and then after primary?
[CUSTOMER][NEUTRAL] $1230.
[CUSTOMER][NEUTRAL] And 10 cents.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Same facility?
[CUSTOMER][NEUTRAL] Yeah, same facility, Mercy Hospital.
[AGENT][NEUTRAL] OK, alright, I'm gonna put you on a brief hold while I look this one up. I'll be right back.
[CUSTOMER][NEUTRAL] Sure, sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] 23,010 right 30609.
[AGENT][NEUTRAL] 355.
[AGENT][NEUTRAL] 0178.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] the world
[AGENT][NEUTRAL] I'll be doggone.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you for holding for me. [PII]. I've got this claim for you is 355.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 0178.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim was
[CUSTOMER][NEUTRAL] Oh, I'm sorry, your voice is breaking.
[AGENT][NEUTRAL] 8. Can you hear me?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yes, I can hear. I have the claim number. I have a, you know, I, we received the claim, uh, um, a different claim number that is 356-0428.
[AGENT][NEUTRAL] Yes, the claim
[AGENT][NEUTRAL] OK, let me look up that claim number.
[AGENT][NEUTRAL] Yes, that number that you gave me, the 356-042-8 is just saying that it's a duplicate claim number. So the original claim number.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is the 355-0178.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And that claim was paid.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, how much was it paid?
[AGENT][NEUTRAL] $1230.10.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] When was it paid?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Did you get the check number?
[CUSTOMER][POSITIVE] Uh, uh, sorry, I, I can, uh, I, I didn't hear you. Your voice is breaking. It's perfect now. Can you please repeat that for me?
[AGENT][POSITIVE] OK. Sorry about that.
[AGENT][NEUTRAL] Yes, 202-2338 is the check number.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, OK. When was it paid?
[AGENT][NEUTRAL] And the check.
[AGENT][NEUTRAL] Was issued on [PII], [PII].
[AGENT][NEUTRAL] January it was cashed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, it's on [PII].
[CUSTOMER][NEUTRAL] I try, yeah.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Where was this went to? May I have the address?
[AGENT][NEUTRAL] Oh, it was sent to the insured.
[CUSTOMER][NEUTRAL] OK, in short
[AGENT][NEUTRAL] Yeah, it was it was uh sent to the insured.
[CUSTOMER][NEUTRAL] So what can be done here? Can we build this claim to the member then?
[CUSTOMER][NEUTRAL] So that they can pay the what is that?
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] We don't give patient responsibility so that would be up to you guys how you want to bill.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] No, we haven't received the payment, right? The payment was bent to the member. You didn't pay us anything.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right. So, right, I understand, but that would be.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Up to the provider to decide what to do as far as the rest of the balance.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Now I can send you the EOB if you would like.
[CUSTOMER][POSITIVE] Yes, please. Yes, please.
[AGENT][NEUTRAL] OK, let me get that together and I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, [PII], I have that you'll be on its way to you now.
[CUSTOMER][POSITIVE] Yeah, OK, sorry, thank you so very much. That's all for now. Have a nice day. Bye-bye.
[AGENT][POSITIVE] You have a wonderful day too. Thank you for calling APL. There's nothing else I can help you with.
[CUSTOMER][POSITIVE] Yeah, that's all for today thank you.
[AGENT][POSITIVE] OK, bye-bye, [PII]. You have a good night. Thanks for calling APL.
[CUSTOMER][NEUTRAL] Yeah bye bye.
[CUSTOMER][NEUTRAL] Bye.