AccountId: 011433970860
ContactId: 2e9a4a8c-bddf-4ae5-b6e3-e6a3c729ddf4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1604800 ms
Total Talk Time (AGENT): 441315 ms
Total Talk Time (CUSTOMER): 586546 ms
Interruptions: 8
Overall Sentiment: AGENT=1.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/2e9a4a8c-bddf-4ae5-b6e3-e6a3c729ddf4_20250528T17:09_UTC.wav
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[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Hi, [PII] calling from Mercy Hospital. I'm checking on a claim. Can you please help me with that?
[AGENT][NEUTRAL] Yes, [PII], I can help you with the claim. May I please get your callback number, sir?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] Thank you. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure, the patient's, uh, first name is [PII]. Last name is [PII], and the policy number is 02549980.
[AGENT][NEUTRAL] OK, let me pull up that policy real quick for us.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] OK, and then what is the date of service please?
[CUSTOMER][NEUTRAL] Sure, for this one, the date of service is [PII], and it's for the total charge amount of $2,352.95.
[AGENT][NEUTRAL] OK, and the facility was, was Mercy Hospital, is that correct?
[CUSTOMER][POSITIVE] That's right.
[AGENT][POSITIVE] OK, thank you so much. [PII], I'm gonna put you on a quick hold while I look up this claim for us and I'll be right back, sir.
[CUSTOMER][NEUTRAL] 842-401 right?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Sure. You are on hold.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you so much, [PII], for holding for me. I've got the claim information for you. The claim number is 3545452.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] The claim was paid $50.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] With check number 2022135. After that $50 was paid, it maxed out the benefit for that date of service according to the patient's policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And let me look and see.
[CUSTOMER][NEUTRAL] Mhm. And
[CUSTOMER][NEUTRAL] Sure, and I just want to ask you.
[AGENT][NEUTRAL] And the check has cleared the bank.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] Uh yeah, thanks for that information. I do really appreciate that. Like, uh, sorry to cut you off. I just want to, uh, get confirm we received the $50 on this claim and like the provider has still has balance of $2,352.95. Is it the patient responsibility?
[AGENT][NEUTRAL] We don't give patient responsibility. We let the provider determine that.
[CUSTOMER][NEUTRAL] 157.
[CUSTOMER][NEUTRAL] Hm. So what can be done because the provider total expected amount for the claim is $2,402.95 and you just now stated that uh as for the patients plan only $50 are left and you guys paid that, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So, ah, now this can be covered and we can bill it to the member, the balance.
[AGENT][NEUTRAL] Uh, that's determined by your provider what they want to do.
[CUSTOMER][NEUTRAL] Mhm. OK, it's provided call, right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Thanks for that. And can you just let me know for this on the claim received in the process date?
[AGENT][POSITIVE] Yes, sir. Let me get that for you real quick.
[CUSTOMER][NEUTRAL] Hm, sure.
[CUSTOMER][NEUTRAL] 345 and I.
[AGENT][NEUTRAL] We received the claim on [PII].
[AGENT][NEUTRAL] And processed it on [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And I just want to ask you one more question regarding this claim. Can you just check and let me know how many ER services can patient get on a single calendar year? Do you have that information?
[AGENT][NEUTRAL] Let me check real quick.
[AGENT][NEUTRAL] See if that will pull up.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And this is just to verify benefits. It's not a guarantee of payment. The insured gets 2 visits per calendar year.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK, 2 visits per calendar year, right?
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] And it was the uh last visit for a year and you guys paid $50 right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And your name?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] OK [PII], uh, can you help me with the reference number for this number and I have another number so if you can help me on that too.
[AGENT][NEUTRAL] OK, yes, um, what is the next members?
[AGENT][NEUTRAL] Name, date of birth, and policy number?
[CUSTOMER][POSITIVE] Uh, sure, definitely I can provide you that just a minute.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, uh, the next, uh, member's first name is [PII], last name is [PII]. Date of birth is [PII], and the policy ID is 202582808.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, I've got the policy pulled up. May I please have the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] Sure, the date of service is [PII]. The total charge amount is $155 even.
[AGENT][NEUTRAL] OK, thank you. And is it for the same facility?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, actually, the tax ID will be different.
[AGENT][NEUTRAL] OK, what is that?
[CUSTOMER][NEUTRAL] Uh, it's for, it's Mercer Hospital Bonneville.
[CUSTOMER][NEUTRAL] And the tax ID is [PII].
[AGENT][POSITIVE] OK, thank you so much. I'm gonna put you on a brief hold while I look up this claim for us, [PII] and I'll be right back sir.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you, [PII]. This is [PII] back with you again. So I have the claim information for you. The claim number is 3552316, and the claim has been denied as non-covered under the patient's plan.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, non-covered under the member's plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And uh the balance with the patient response today did I got it right?
[AGENT][NEGATIVE] We don't give patient responsibility.
[CUSTOMER][NEUTRAL] OK, it's a provider's call, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, uh, thanks for that. Can you help me with the claim, the process for this one?
[AGENT][NEUTRAL] Yes, let me look that up real quick.
[CUSTOMER][NEUTRAL] And just wanted to confirm uh why the services are not for did member have any limited benefit plan?
[AGENT][POSITIVE] Uh, yes, that's correct.
[CUSTOMER][NEGATIVE] OK, that's the reason the services are not good, right?
[AGENT][NEGATIVE] It's not covered.
[AGENT][NEUTRAL] It's right, it's not covered under the, uh, policy certificate.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] On a patient's plan.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Can you provide me the claim with you and the process date?
[AGENT][NEUTRAL] Yes sir, I'm looking it up now.
[CUSTOMER][NEUTRAL] Mm sure.
[CUSTOMER][NEUTRAL] I don't
[AGENT][NEUTRAL] Actually, I'm looking at this.
[AGENT][NEUTRAL] You said the amount was $155?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] All right, let me look.
[AGENT][NEUTRAL] I may have looked at the wrong claim. Let me check this out for a moment real quick.
[CUSTOMER][POSITIVE] Hm hm hm, no problem. Take your time.
[AGENT][NEUTRAL] OK, I do see that this claim was paid to Mercy Hospital $150.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] With check number 2044.
[AGENT][NEUTRAL] 621.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][POSITIVE] So it was paid. I apologize for that.
[CUSTOMER][NEUTRAL] Uh, but just a minute, uh, it's for the same.
[AGENT][NEUTRAL] I, I looked at a diff.
[CUSTOMER][NEUTRAL] Ah, let me check on that. It's for the same, right? Mercy Hospital Bonville. It was paid.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, let me check on that because we haven't received any payment regarding that till now.
[AGENT][NEUTRAL] Let me tell you when it went out.
[CUSTOMER][NEUTRAL] And you said yeah sure just check over the payment details did it got cashed and it's a single payment or bulk.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, I'm showing that it, it's just been sent [PII].
[AGENT][NEUTRAL] A single check
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, [PII] it was sent a single check, right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] Thanks for that.
[CUSTOMER][NEUTRAL] Just a minute.
[AGENT][NEUTRAL] And that's also the process date for the claim.
[CUSTOMER][NEUTRAL] Mhm mhm. Sure, sure. And uh, can you also help me to read about the claim number for this one? Can you repeat that for me, please?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] It's 359-491-6.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] 16. OK, just a minute, let me document that.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Just one moment, let me document that from my end.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] And how's your day going today?
[AGENT][POSITIVE] It's going great today. So far, it's been busy, which makes it go by fast.
[CUSTOMER][NEUTRAL] Yeah, waiting.
[CUSTOMER][NEUTRAL] Yeah, waiting for the weekend, right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Always
[CUSTOMER][NEUTRAL] And, uh, yeah.
[CUSTOMER][NEUTRAL] And, uh, [PII], can you uh repeat the paid amount again?
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] Yes sir, it was, let me go back over to the check again real quick.
[AGENT][NEUTRAL] The paid amount is $150.
[CUSTOMER][NEUTRAL] OK, $150 right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] Thanks for that, just a minute.
[CUSTOMER][NEUTRAL] OK, uh, thanks for that information and letting me know that information to be and what will be the reference number for this one, so I think we can go ahead with the next one.
[AGENT][NEUTRAL] OK, the reference number is gonna be my name [PII] and today's date.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, sorry, just, uh, let me know when you're ready so I can, uh, provide you with the next member name, date of birth, and the policy ID.
[AGENT][NEUTRAL] OK, what's the next member's name, date of birth, and policy ID?
[CUSTOMER][NEUTRAL] Uh yeah, sure. The policy ID it's D as in Delta 44504814.
[CUSTOMER][NEUTRAL] And the patient's first name is [PII]. Last name is [PII]. Date of birth is [PII].
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, this number that you gave me is for 90 Degree benefits.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Do you have [PII]'s um social and I can try to pull it up that way?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I do have it's [PII].
[AGENT][NEUTRAL] OK, let me pull that up real quick.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, she's not pulling up in my system. Uh, let me try the name.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Actually, yeah, actually it's a baby. Let me check. I think mother is the same [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Oh, probably not.
[CUSTOMER][NEUTRAL] Mhm, let me check.
[AGENT][NEUTRAL] Oh, it's the same one that we just looked at?
[CUSTOMER][NEUTRAL] Yeah, like, ah, for this, uh, before we look at for mother and now I'm telling you for this baby [PII].
[CUSTOMER][NEUTRAL] It's a baby, uh, the same member ID the previously which I provided you.
[AGENT][NEUTRAL] OK, let me look.
[CUSTOMER][NEUTRAL] And I can provide the claim number too if you want.
[AGENT][NEUTRAL] OK, let me check it out real quick.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, I do see [PII] on the policy. We just didn't have her social social in our system. um, can you please get you said you have the claim number?
[CUSTOMER][NEUTRAL] Mhm hm.
[CUSTOMER][POSITIVE] Yeah, I do have that uh just a minute, I will help you with that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Hm, the claim number listed from our end it's 356-6125.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mercy Hospital, Fort [PII].
[AGENT][NEUTRAL] Um, and what was the charge amount?
[CUSTOMER][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] It's $1,842 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] OK, this one has been denied because the benefit that amount for the date of service was met.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Benefit maximum for the date of service was met, right? Yeah services, ah, can you check, uh, what is the limit is a member like the baby is having for the calendar year.
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me um look at this data service.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Right, uh, so this is the same thing, um, where they get two visits per calendar year, uh, for the ER and it pays $150 and this is just to verify benefits, it's not a guarantee of payment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. OK, so you mean to say, uh, the, we have only 2 services for, uh, to be pay like only can be paid to I 2 services for a calendar year which was already been exhausted, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] course
[CUSTOMER][NEUTRAL] And it was paid to the different, uh, facilities, right, or is it the same? Do you have that information still?
[AGENT][NEUTRAL] Uh, looks like a different facility.
[CUSTOMER][NEUTRAL] Mhm, OK, sure, uh, thanks for letting me know that just a minute.
[CUSTOMER][NEUTRAL] And you can't tell me it's a patient response it's a provider call, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Hm, OK, and like I think, I think I for the alley only I have one more data of service which is being left.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hm, can I, can I go ahead with the date of service?
[AGENT][NEUTRAL] Yes, is it for the same member or is it for a different member?
[CUSTOMER][NEUTRAL] Yeah, the same member Ali.
[AGENT][NEUTRAL] [PII], OK, and what is the day's service?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And the charge amount?
[CUSTOMER][NEUTRAL] Yeah, I have two charge amounts and one is for the facility which is $1,158 even and there's a professional claim for the same data service with the amount of $321.
[CUSTOMER][NEUTRAL] 99
[AGENT][NEUTRAL] OK um I'm gonna put you on a quick hold I'm gonna look up this claim and I'll be right back with you [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank thank you [PII] for holding for me so looking on this data service for Ali.
[AGENT][NEUTRAL] I do show that the claim was paid. Uh, the claim number is 356524-3. It was paid $150 with check number 2028473.
[CUSTOMER][NEUTRAL] Yeah, uh, thanks for letting me know. Yeah, I'm uh sorry I was on mute. I forgot that. Uh, just want to ask you, uh, it was paid for $321 is that right?
[AGENT][NEUTRAL] Are you there? OK.
[AGENT][NEUTRAL] No, it was paid for $150. The amount of $1,158 for that data service. I did not find that claim for that amount, but the amount for $321.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That is gonna be claim number 3565243 and it paid $150.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] With check number 20.
[CUSTOMER][NEUTRAL] Yeah, it was paid as for the, mhm, yeah, we received that payment.
[AGENT][POSITIVE] Yes, and it was, um, the check did clear, right.
[CUSTOMER][NEUTRAL] Mhm, yeah, just for this one we have received the payment as you stated, uh, and then the balance will be it's a provide a call we can bill it or not because you just answer a a patient already crossed the ER met.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So it's OK and for the $1,158 can you just let me know where we can resubmit the bill or, uh, like we can, we can't because the member already crossed the.
[CUSTOMER][NEUTRAL] Yeah, I was just.
[AGENT][NEUTRAL] You can go ahead and submit the claim if you want to, um, I can give you both the payer ID number and the claim's mailing address.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Mhm. OK, just a minute, let me note down that.
[CUSTOMER][NEUTRAL] Uh, go ahead with the first mailing address.
[AGENT][NEUTRAL] OK, the mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] That's in [PII].
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] And then the zip code is [PII].
[CUSTOMER][NEUTRAL] OK, and what is the time requiring to submit the claim?
[AGENT][NEUTRAL] That there's not one.
[CUSTOMER][NEUTRAL] Uh, no, I'm fine, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, thanks for that information. Thanks for letting me know. Can you also help me with the payroll ID too?
[AGENT][NEUTRAL] Yes, the payer ID number is 60801.
[CUSTOMER][NEUTRAL] 60801. OK, thanks for that. Thanks for helping me out and letting know, letting me know about this claim.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] Absolutely. You're welcome.
[CUSTOMER][NEUTRAL] And the reference number will be your name and today's date, right?
[AGENT][NEUTRAL] Yes it is.
[CUSTOMER][POSITIVE] OK [PII], thanks for that information and helping me out. I do really appreciate that and I wish you have a great day.
[AGENT][POSITIVE] Well, thank you. I hope you have a wonderful day too, and is that everything I can help you with today, [PII]?
[CUSTOMER][POSITIVE] Yeah, that's what that's what I need for today. Thanks for that.
[AGENT][POSITIVE] You're welcome. You have a good day and thank you for calling APL, sir.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You too, bye for now.
[AGENT][NEUTRAL] Bye-bye, [PII].