AccountId: 011433970860
ContactId: 29d1c2f8-2c7a-41c9-a914-f902008cc36c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 637890 ms
Total Talk Time (AGENT): 184723 ms
Total Talk Time (CUSTOMER): 178709 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/29d1c2f8-2c7a-41c9-a914-f902008cc36c_20250521T14:53_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm [PII] calling on behalf of Mayo Clinic to check on a claim status.
[AGENT][NEUTRAL] Sure, can I get your name one more time?
[CUSTOMER][NEUTRAL] Sure, [PII]. It's um [PII]
[CUSTOMER][NEUTRAL] My last name initial is [PII].
[AGENT][NEUTRAL] OK, and a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, um, the callback number is [PII].
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] Sure, the policy number is 025.
[CUSTOMER][NEUTRAL] 556
[CUSTOMER][NEUTRAL] 33.
[AGENT][NEUTRAL] OK, one moment while I look that up.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Can I get you to verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Sure, the member's name is uh [PII] and date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] And do you have the date of service or the claim number?
[CUSTOMER][NEUTRAL] Sure. I have the date of service.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The date of service is um [PII].
[CUSTOMER][NEUTRAL] And the total charge amount is $2,489.
[AGENT][NEUTRAL] You said [PII]
[CUSTOMER][NEUTRAL] Uh yes. It's [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the bill amount is $2,489.70.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] So for this data of service, uh, I have totally 4 charge amounts.
[CUSTOMER][NEUTRAL] Um, the claim to be checked.
[CUSTOMER][NEUTRAL] you able to help me with that?
[AGENT][NEUTRAL] Yeah, did you say you have 4 others?
[CUSTOMER][NEUTRAL] No, I have 3 others.
[AGENT][NEUTRAL] 3, OK.
[CUSTOMER][NEUTRAL] Totally 4.
[AGENT][POSITIVE] Yes, I can help you with all of that um let's go one by one.
[AGENT][NEUTRAL] Do you need the claim number for this?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me pull it up real quick.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, for this claim, it looks like we received it on [PII].
[AGENT][NEUTRAL] It was processed on.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The claim number is 35.
[AGENT][NEUTRAL] 97.
[AGENT][NEUTRAL] 844.
[AGENT][NEUTRAL] And it looks like this claim was denied because our records indicate that premium for this service date was not received and therefore benefits are not payable. If the premium is being paid through COBR, you'd need to contact them.
[AGENT][NEGATIVE] But they didn't, they didn't pay their premiums for this month.
[CUSTOMER][NEUTRAL] OK. Uh, the patient have not
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Patient have not paid the premier, right?
[AGENT][NEGATIVE] Right, the premium wasn't paid for that month, therefore the services were denied due to no premium being paid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh is there any letters sent from your side to send, uh, pay the premium to the patient?
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] It looks like it would have been sent to the provider's office and then they would they would handle that.
[AGENT][NEUTRAL] Because they filed the claim?
[CUSTOMER][NEUTRAL] OK, it has been sent to the provider's office but not the patient, right?
[AGENT][NEUTRAL] Right, it was sent to the provider's office.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I'll check if I have received it.
[CUSTOMER][NEUTRAL] Give me a minute.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Is it, uh, it was sent on.
[CUSTOMER][NEUTRAL] [PII], is it?
[AGENT][NEUTRAL] Looks like mm
[AGENT][NEUTRAL] Well it was processed on [PII], so it probably would have been around that time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But no, we have not received any correspondence from your side. I'm sorry. Uh, so,
[AGENT][NEUTRAL] Yeah let me see.
[CUSTOMER][NEUTRAL] Uh, can I have the UOBs of, uh, this data of service claims?
[CUSTOMER][NEUTRAL] And also the correspondence which you, you have sent from your site through the fax. Is it possible?
[AGENT][NEUTRAL] OK. What's your fax number?
[CUSTOMER][NEUTRAL] Sure, the fax number is.
[CUSTOMER][NEUTRAL] Give me a minute, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And attention to my name, it's [PII] and my last name initial is [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have totally 4 bill amounts for the same date of service.
[AGENT][NEUTRAL] OK, so it's for, is it for the same patient?
[CUSTOMER][NEUTRAL] Yes, it's for the same patient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said it was for [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what were the bill amounts?
[CUSTOMER][NEUTRAL] Yes, the next bill amount is $118 even.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the next one is.
[CUSTOMER][NEUTRAL] $68 even.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the last one is $925 even.
[AGENT][NEUTRAL] OK. Give me one moment.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I just need the claim numbers of those uh claims. I think it will be denied for the same reason.
[AGENT][NEUTRAL] Yes, they were all denied for the same reasons.
[CUSTOMER][NEUTRAL] But I just need uh
[CUSTOMER][NEUTRAL] Claim number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number for the charge of $118 is 35.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 97878.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the claim number for the $68.
[AGENT][NEUTRAL] It's 359-7.
[AGENT][NEUTRAL] 849.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the claim number for the $925 is 35.
[AGENT][NEUTRAL] 97.
[AGENT][NEUTRAL] 847.
[CUSTOMER][POSITIVE] OK, thank you so muc[PII] for that um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And I will go ahead and send out the EOB for the first one that we discussed um it'll have the same denial reason on it.
[AGENT][NEUTRAL] And uh you should expect that. Give it about 30 minutes just in case, OK?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Sure, thank you so much, [PII].
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] And uh we'll contact the patient and let them know.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, that's it from my side. Thank you. And is there any reference number for the call?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] We don't have reference numbers, but you can use my name and last initial in today's date, so [PII].
[CUSTOMER][POSITIVE] OK, thank you so much, [PII] and have a great day ahead.
[AGENT][POSITIVE] Have a great day. Thank you for calling APL.
[CUSTOMER][POSITIVE] Take care. Bye-bye.
[AGENT][NEUTRAL] Bye.