AccountId: 011433970860
ContactId: 17dc6c28-0589-408e-8947-fbee0ba795cc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 312679 ms
Total Talk Time (AGENT): 133619 ms
Total Talk Time (CUSTOMER): 134916 ms
Interruptions: 4
Overall Sentiment: AGENT=1.1, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/17dc6c28-0589-408e-8947-fbee0ba795cc_20250127T13:37_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling with Saint Mary's Regional Medical Center. I'm calling to follow up on a claim that we had billed y'all. It looks like United Healthcare had paid and y'all were secondary, and we had submitted that claim back beginning of December. I wanna see if I don't see anything in your system, so I'm following up to make sure we sent it to the correct place and all too.
[AGENT][NEUTRAL] OK [PII] so you're just wanting to verify um that we received the claim that you all submitted, is that correct and check status?
[CUSTOMER][NEUTRAL] Uh, yes, and my name is [PII].
[AGENT][POSITIVE] Yes, ma'am. I'm so sorry. I said [PII], you're with Saint Mary's. I apologize. I have that. OK. Well, [PII], I can help you with that.
[CUSTOMER][NEUTRAL] Oh that's OK, yes.
[CUSTOMER][NEUTRAL] And what was your name again please? OK.
[AGENT][NEUTRAL] I can, I'm sorry, what did you ask me?
[CUSTOMER][NEUTRAL] Oh, what was your name again please?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] [PII], thank you.
[AGENT][NEUTRAL] Uh huh, you're welcome. And what is a good call back number for you please, May, uh, [PII]? I don't know.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII] yes it's [PII] and that's direct.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. And [PII], what is the member's policy number?
[CUSTOMER][NEUTRAL] It's 01888636.
[AGENT][NEUTRAL] OK thank you one moment while I get the member's information pulled up please.
[AGENT][NEUTRAL] Alright, give me just a moment to look at a couple of things, please.
[AGENT][NEUTRAL] OK, and any information that I do provide for you today, [PII], will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] That's gonna be [PII]. Let me verify that real quick because sometimes when I see and whenever they actually end up billing can be a little different. Looks like no, it's date [PII], just the one day. It's for $142 even.
[AGENT][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, so there is not a claim on file for 11-7-2024 for him. Now, [PII], this policy was active from [PII].
[AGENT][NEUTRAL] To its term date of [PII], and there is no other policy active with us beyond that.
[CUSTOMER][NEGATIVE] Oh OK so he wasn't even eligible on this data service.
[AGENT][NEUTRAL] Date.
[AGENT][NEUTRAL] No, ma'am. That is correct, not with our company.
[CUSTOMER][NEUTRAL] And there was no claim.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so he wasn't active there and no other policy. What is your payer ID just or do you have a payer ID?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK, because I know they looks like they build it paper because they billed it with the EOB from United Healthcare, I think. OK, so he does not have y'all anymore but he listed y'all as secondary, OK, um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And we did not, again, if it's the data service is [PII], we did not receive a claim for that data service.
[CUSTOMER][POSITIVE] Yes, that's correct.
[CUSTOMER][NEGATIVE] So you OK, you would have denied it, not eligible anyway though.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, so anyway, no need to continue with that then. OK, we'll have to try to find out if there's anything else. OK, thank you for your help. May I get a reference number please?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Sure, you would use my name along with today's date.
[CUSTOMER][POSITIVE] OK, thank you so much. I hope you have a wonderful weekend. uh, gosh, I'm already at the weekend, sorry, a wonderful week.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, I, see, I'm calling you [PII], and you're you're ready for the weekend, but I'm gonna second that. I know. I, I'm gonna go with you 100% on that one today.
[CUSTOMER][POSITIVE] I'm already ready and I just started.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][POSITIVE] OK, [PII]. I hope you do too. You're very welcome and thank you again for calling APL. Yes, ma'am. Bye-bye.
[CUSTOMER][POSITIVE] Well I hope you have a good day thank you thank you.
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][POSITIVE] You're welcome thanks you too bye.