AccountId: 011433970860
ContactId: 0f336770-feb6-4a2a-ac03-71bd28861419
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 702840 ms
Total Talk Time (AGENT): 209905 ms
Total Talk Time (CUSTOMER): 157960 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/0f336770-feb6-4a2a-ac03-71bd28861419_20250128T15:43_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling from Oxford Diagnostic Center to check on a claim status. Could you please help me with that, [PII]?
[AGENT][POSITIVE] Yes, I'll be more than happy to assist you with the claim status and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, sure. My callback number is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, sure. The policy number is 910108.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, sure. And uh the patient name is [PII] and the 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 and the total bill?
[CUSTOMER][NEUTRAL] Yes, sure. The date of service is [PII] and the bill amount is $1140 even.
[AGENT][NEUTRAL] Thank you for that and all the inform again, all the information provided is a verification of benefits, not a guarantee of payment, and that was [PII] $1140.
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, here it is. So I'm showing we received the claim on [PII].
[AGENT][NEUTRAL] Hold on.
[AGENT][NEUTRAL] Sorry, I looked at the wrong line. [PII], we received the claim.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, [PII], we received the claim.
[AGENT][NEUTRAL] That claim number is 349.
[AGENT][NEUTRAL] 0927.
[AGENT][NEUTRAL] And on [PII], the claim was denied?
[AGENT][NEGATIVE] And hold on one moment, I'm getting that denial reason for you now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, all payable benefits were applied to the deductible of $750.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] Uh, may I know the allowed amount?
[AGENT][NEUTRAL] So for outpatient, the policy will pay up to $4750 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, it's an annual deductible, right?
[AGENT][NEUTRAL] Right, the deductible is $750 per calendar year.
[CUSTOMER][NEUTRAL] And also, may I know how much so for patient [PII]?
[AGENT][NEUTRAL] OK, we don't usually give all this information to the provider. The claim was denied um because it was applied to the deductible. Did you need a copy of the explanation of benefits?
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Yes. Could you please send me that?
[AGENT][NEUTRAL] OK, and what's a good fax number for you?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] 3.
[AGENT][NEUTRAL] Thinking, do I need to put attention, [PII]?
[CUSTOMER][NEUTRAL] It's, yes, it's my name.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And may I know when will I receive the EOB?
[AGENT][NEUTRAL] Um, I just sent it, so we usually say to give it at least an hour to be received from fax. So if you don't receive it by the end of day today, um, you can definitely give us a call and we can resend it.
[CUSTOMER][NEUTRAL] OK. Uh, I do have one more claims to check. Could you, uh, help me with that?
[AGENT][NEUTRAL] OK, and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] It's 2, this one and uh next.
[AGENT][NEUTRAL] OK, hold on.
[AGENT][NEUTRAL] The one that we're getting ready to do?
[CUSTOMER][NEUTRAL] Yes, but uh before that, can I get the call reference number for this client?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So there's no call reference number for the entire call. It will be my name and today's date, and that's [PII]. And hold on one moment, let me just um fax the explanation of benefits over to you before we go to the next one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So I have sent the um explanation of benefits over to you. And what is the next member's policy number?
[CUSTOMER][NEUTRAL] The next member's policy number is 982-521.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure. The patient name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service um for the claim and the total bills?
[CUSTOMER][NEUTRAL] The date of service is [PII]. And the bill amount is $1,537 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And would it be the same provider or it's a different provider for this one?
[CUSTOMER][NEUTRAL] Uh, it's a different provider?
[AGENT][NEUTRAL] OK, and who's that provider?
[CUSTOMER][NEUTRAL] It's Baptist Memorial Hospital.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'm showing that the claim was received on [PII], I'm sorry, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 347568-6.
[AGENT][NEUTRAL] And on [PII], the claim was denied?
[AGENT][NEUTRAL] Because the services were rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] OK. Uh, can I get the
[AGENT][NEUTRAL] This policy
[AGENT][NEUTRAL] This part, go ahead.
[CUSTOMER][POSITIVE] Effective and for
[CUSTOMER][NEUTRAL] Sorry, uh, you go ahead.
[AGENT][NEUTRAL] This policy was effective from [PII].
[AGENT][NEUTRAL] And there were no other policies after [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Uh, thank you so much for assisting me. Could you please send me the copy of an EB also?
[CUSTOMER][NEUTRAL] To the same fax number?
[AGENT][NEUTRAL] Sure, um, and again, that's [PII].
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][POSITIVE] All right, so I'll go ahead and send this over for you now. And [PII], was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK. I do have one doubt. Uh, so, [PII] American Republic, is that your insurance or it's a different?
[AGENT][NEUTRAL] American Republic is different.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII], for assisting me today. Have a wonderful day and stay safe. Bye-bye.
[AGENT][POSITIVE] Thank you also and thanks for calling APL. Bye-bye.