AccountId: 011433970860
ContactId: 1b871cf3-4d05-4d78-8320-5013426ceefc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 512979 ms
Total Talk Time (AGENT): 127684 ms
Total Talk Time (CUSTOMER): 151334 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/1b871cf3-4d05-4d78-8320-5013426ceefc_20250528T19:23_UTC.wav
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[AGENT][NEUTRAL] Afternoon, thanks for calling APL is.
[CUSTOMER][NEUTRAL] Hi, I'm sorry, could you repeat your name again?
[AGENT][NEUTRAL] Sure, it's [PII]
[CUSTOMER][NEUTRAL] OK, last name first initial?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Thank you, [PII]. My name is [PII] and I'm calling from Oklahoma Heart Hospital and I'm calling to get a claim status on a couple of patients.
[AGENT][NEUTRAL] OK, I can verify claim status for you. And Ms. [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] 119136.
[AGENT][NEUTRAL] Uh, it sounds like it's missing a number. Do you have a copy of the card in front of you?
[CUSTOMER][NEUTRAL] Um, let me see if I can pull it up right quick.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Maybe a 0. Sometimes we leave zeros off.
[CUSTOMER][POSITIVE] That helps.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Let's see, I'm pulling it up now.
[CUSTOMER][NEUTRAL] She says card.
[AGENT][NEUTRAL] What's the patient's name?
[CUSTOMER][NEUTRAL] OK, well, it just says 1191364. [PII].
[AGENT][NEUTRAL] 64
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and verify his date of birth.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK. And what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] [PII] for $228.54.
[AGENT][NEUTRAL] I apologize, give me that total charge amount again.
[CUSTOMER][NEUTRAL] 228.54.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Go
[AGENT][NEUTRAL] I don't show we received that claim and this patient's policy had terminated on [PII], so they were not active at the time of service.
[CUSTOMER][NEUTRAL] OK, terms of uh.
[CUSTOMER][NEUTRAL] OK, may I have a um.
[CUSTOMER][NEUTRAL] Reference number for the call.
[AGENT][NEUTRAL] Uh, if you like, you may use my name in today's date.
[CUSTOMER][NEUTRAL] OK, that's fine. Alright, I have one more.
[AGENT][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK. And what is that next policy number, Ms. [PII]?
[CUSTOMER][NEUTRAL] OK. I have 01846422.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and patient's name, date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, and what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] Amount of the charge is
[CUSTOMER][NEUTRAL] Oh, got it over here. Uh, $448.51.
[AGENT][NEUTRAL] And the data service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I understand.
[AGENT][NEUTRAL] See
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Uh, it looks like the claim process is not a cover loss under the plan, therefore, it's not payable.
[CUSTOMER][NEUTRAL] It's not a covered loss.
[AGENT][NEUTRAL] Uh, yes, ma'am. Part of the policy is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, do you have the EOB? Can I have that faxed to me?
[AGENT][NEUTRAL] Sure. What's your fax number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. And that's [PII]?
[CUSTOMER][NEUTRAL] But
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But could I still have the information as well?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, like the claim, the claim number and one is received and processed.
[AGENT][NEUTRAL] Uh, [PII] received [PII], process on [PII].
[AGENT][NEUTRAL] Uh, the claim number is 359-6843.
[CUSTOMER][NEUTRAL] OK. And that due to not a covered loss, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] How long will it take for that um EOB for me to receive that EOB?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I'm gonna send it out in a few moments.
[AGENT][NEUTRAL] Just trying to pull it up.
[CUSTOMER][NEUTRAL] OK. Now when you say that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So there was no payment.
[CUSTOMER][NEGATIVE] No patient responsibility.
[AGENT][NEUTRAL] Uh, well, we don't give patient responsibility. We just verify how the claim was processed and it looks like it's just process it's not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And what was the reason why it wasn't covered?
[AGENT][NEUTRAL] It stated it's not a covered loss on the plan. It doesn't show any breakdown in detail, but it just says it's not a covered loss per the policy contract.
[CUSTOMER][POSITIVE] I support it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. All right. And is there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, that'll be all. Thank you so much.
[AGENT][POSITIVE] OK, uh, you're welcome. Thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too. Bye bye.
[AGENT][NEUTRAL] I