AccountId: 011433970860
ContactId: 23753f41-0443-4c3c-9fe5-e412a39524ec
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 647659 ms
Total Talk Time (AGENT): 280664 ms
Total Talk Time (CUSTOMER): 203666 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/23753f41-0443-4c3c-9fe5-e412a39524ec_20250306T13:38_UTC.wav
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[AGENT][POSITIVE] Good Morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Hi, good morning, [PII]. Um, good morning.
[AGENT][POSITIVE] Good morning.
[CUSTOMER][NEUTRAL] Um, what.
[CUSTOMER][NEUTRAL] I'm so sorry. Let me just switching. Hi, good morning. This is from Baptist Hospital in [PII]. How are you?
[AGENT][NEUTRAL] I'm so sorry, but I could not hear your voice sounded so far away at the beginning. I couldn't hear, I didn't understand your name.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] OK. Can you hear me better now? My phones are acting up today. This is [PII] from Baptist Hospital. [PII] from [PII]. Mhm. Yeah, I want to check if this, this member, we had some um some error here in creating an insurance, um.
[AGENT][NEUTRAL] Yes,
[AGENT][NEUTRAL] Yeah, um, so.
[AGENT][NEUTRAL] OK, [PII], how can I help you?
[CUSTOMER][NEUTRAL] And I wanted to see if this, this patient is still covered with you, please?
[AGENT][NEUTRAL] OK, sure. You're just needing to verify if the policy is still active, [PII]?
[CUSTOMER][NEGATIVE] Yes, yes, because they have the wrong insurance here.
[AGENT][POSITIVE] Yes ma'am, I can help you with that.
[AGENT][POSITIVE] Oh, OK, sure, I can help you. Well, first off, what is a good call back number for you please?
[CUSTOMER][NEUTRAL] Yes, you need the number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Where am I? Where am I? [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, thank you. And now the member's policy number, please?
[CUSTOMER][NEUTRAL] 02255811.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] And you're, you said you're only needing eligibility, not benefit information, [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes. Yes, uh-huh.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And any information that I do provide for you would be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, date of birth, uh, [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show she is the supplemental excuse me, the policy holder on the supplemental policy. It is active and the effective date is [PII].
[AGENT][NEUTRAL] Now, [PII],
[CUSTOMER][NEUTRAL] I'm still active?
[AGENT][NEUTRAL] Yes ma'am, it is, and if you all will be filing a claim with APL for her, we will also need to receive a copy of the primary insurance company's explanation of benefits along with the claim for review and then you may already have this, uh, but we have our portal in which once we process our claim you should be able to check claim status and by going to [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes. Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, good.
[CUSTOMER][NEUTRAL] OK. And what's your mailing address again, please? Just to put it in here in case.
[AGENT][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] That is [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK. OK, great. Thank you so much, [PII]. Have a great day. Thank you.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] Oh well, I hope you do too. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Not right now. Have a great day.
[AGENT][POSITIVE] OK. Well, yes, ma'am. You too, and uh thank you again for calling APL today, [PII].
[CUSTOMER][NEUTRAL] 00, wait a minute, [PII]. I'm sorry, wait a minute, wait a minute. I'm so sorry. Can I get to check the status of another patient claim since I have you on the phone?
[AGENT][NEUTRAL] A different patient you're needing claim status on?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Yes, ma'am, one moment please.
[AGENT][NEUTRAL] And also the same will apply on this one. Any information provided would be a verification of benefits and not a guarantee of payment. What is the policy number for this member?
[CUSTOMER][NEUTRAL] Yes, on this one is um.
[CUSTOMER][NEUTRAL] Uh, what am I, one second, just go back here.
[CUSTOMER][NEUTRAL] 01907958.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, so now
[AGENT][NEUTRAL] This policy is, she was a subscriber on this policy, but this policy is no longer active. This policy was active from [PII].
[AGENT][NEUTRAL] She does have another policy that is active with a different policy number.
[AGENT][NEUTRAL] So, um, what is your date of service on this claim?
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so yes ma'am, that would be the correct policy number for me to look at, so give me just one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What is the data service and total bill amount, please?
[CUSTOMER][NEUTRAL] Yes, um, see on here.
[CUSTOMER][NEUTRAL] The the data service is um.
[CUSTOMER][NEUTRAL] Oh, I didn't pay anything. Um, [PII], and the bill amount is 7,657.
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] OK, give me just a couple of moments to look at a couple of things.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] And you did say the bill amount is 7657, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so this claim was received. The received date was on [PII].
[AGENT][NEGATIVE] It processed and denied on.
[AGENT][NEGATIVE] And I just lost that information.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The claim number for this is 3488588.
[AGENT][NEUTRAL] And the reason for the denial on this claim states.
[AGENT][NEUTRAL] Benefits are payable only if your major medical insurance provider provides benefits. If this claim is later paid by your major medical insurance, please send the explanation of benefits showing benefits were paid.
[CUSTOMER][NEUTRAL] Yeah, I see what you mean. The primary, I'm just looking at the claim now. I don't know why they haven't paid. Yeah, we shouldn't have billed you guys because the primary didn't pay. I'm gonna check more on that. I just saw that. OK, so what is um the effective date? Oh, the patient is, you said um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so the patient, that's the correct, um.
[CUSTOMER][NEUTRAL] The policy number I gave you for this period of time.
[AGENT][NEUTRAL] For this state of service, yes, ma'am. It was active from [PII] and termed [PII] before her other policy picked up, but yes ma'am.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] This is the correct policy for your data service.
[CUSTOMER][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] For this date, for this data service. OK. Um, perfect. Uh, but the patient is covered, is it, there's a new policy?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Number?
[AGENT][NEUTRAL] Yes ma'am, for future dates of service now if you're gonna be filing on this claim, you will need to use this policy.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Right, but I'm just putting in the notes on the system for, you know, whenever if she comes back now pre now currently.
[AGENT][NEUTRAL] OK, so there is also another policy that is active with an effective date of [PII], and that is policy number 253-8203.
[CUSTOMER][NEUTRAL] OK. And it's active for [PII] and still active.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] All right. Perfect. OK.
[CUSTOMER][POSITIVE] OK, great. Thank you so much um.
[AGENT][POSITIVE] Well, you're certainly welcome.
[CUSTOMER][NEUTRAL] We'll look into this one.
[AGENT][NEUTRAL] OK. Well, is there anything? Yes, I need to. Can I help you with anything else, [PII]?
[CUSTOMER][POSITIVE] Have a great day.
[CUSTOMER][POSITIVE] No, that's it. Thank you so much for your help today. Take care.
[AGENT][POSITIVE] OK, well, you're certainly welcome. Yes, ma'am. You too, and thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][POSITIVE] Thank you. You're welcome. Bye-bye. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.