AccountId: 011433970860
ContactId: 31a63e89-829c-4fbf-a025-36c9fc42f115
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 659530 ms
Total Talk Time (AGENT): 120173 ms
Total Talk Time (CUSTOMER): 240331 ms
Interruptions: 1
Overall Sentiment: AGENT=-0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/31a63e89-829c-4fbf-a025-36c9fc42f115_20250325T19:17_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL this is.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is, yeah, hi, this is [PII] calling from Mercy Facility checking on the claim status. Uh, this, uh, I have a few questions regarding the claim actually, not regarding the status, but having a few questions. So may I have your name, please?
[AGENT][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] [PII]? Can you spell it out, ma'am?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Can you just spell out the name?
[AGENT][NEUTRAL] Yes, [PII]
[AGENT][NEUTRAL] And last initial is [PII].
[CUSTOMER][POSITIVE] Thank you so much for that.
[CUSTOMER][POSITIVE] Thank you so much for that.
[AGENT][NEUTRAL] [PII], do you have a good callback number?
[CUSTOMER][NEUTRAL] Definitely. The callback number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And you had a a couple of questions on a claim, is that correct?
[CUSTOMER][POSITIVE] Yes, ma'am. Yes, ma'am. Correct.
[AGENT][NEUTRAL] OK, do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Uh, I was about to check that.
[CUSTOMER][NEUTRAL] OK. So the patient policy number is, it is 025124772.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And do you have the patient name and date of birth?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The patient name is [PII], [PII], last name is [PII] [PII].
[AGENT][NEUTRAL] And what was the date of service?
[CUSTOMER][NEUTRAL] Date of service is [PII].
[AGENT][NEUTRAL] And what was the build out?
[CUSTOMER][NEUTRAL] The bill amount on the claim is, it is $3,589 even.
[AGENT][NEUTRAL] And who's the provider?
[CUSTOMER][NEUTRAL] Uh, Mercy Hospital.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Would you like to have the complete address for that?
[AGENT][NEUTRAL] No, I don't need that.
[CUSTOMER][NEUTRAL] It's a messy. OK, fine. [PII].
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] It looks like we received it more than once. Let me find the original.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] When did you receive this claim?
[AGENT][NEUTRAL] Um, pulling up that we received a duplicate, so I'm pulling up the original claim. Just give me one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] It looks like it was denied for
[AGENT][NEUTRAL] The benefit maximum.
[CUSTOMER][NEUTRAL] No, first, let me know when did you receive. I need a date. I need a date first.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 3508192.
[AGENT][NEUTRAL] Was received 9-13-2024 denied on 9-23-2024, maximum has been met.
[CUSTOMER][NEUTRAL] Received on [PII].
[AGENT][NEUTRAL] 9-132024 and then processed on [PII].
[CUSTOMER][NEUTRAL] [PII], no.
[AGENT][NEUTRAL] 2024.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 1 2nd.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Received on [PII] and
[CUSTOMER][NEUTRAL] Processed on [PII]. And the night for?
[AGENT][NEUTRAL] Maximum
[CUSTOMER][NEUTRAL] Uh, uh, maximum. Got it. And may I have the claim, claim number?
[AGENT][NEUTRAL] 3508192.
[CUSTOMER][NEUTRAL] 3508192, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so ma'am, I would like to request you that last time, ah.
[CUSTOMER][NEUTRAL] Last time we have requested you be on [PII]. Still, we have not received. So I would request you to send me the
[AGENT][NEUTRAL] Do you have access to our online? OK, do you have access to our online portal?
[CUSTOMER][NEUTRAL] Mhm. I just remember this.
[CUSTOMER][NEUTRAL] Yeah, no, ma'am, I want, I can provide you the fax number.
[AGENT][NEUTRAL] OK, what's that?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] What, what was the fax number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah, yeah, I'm giving you my fax number. So [PII]. I'll repeat it's [PII] and.
[AGENT][NEUTRAL] And how do you spell your name?
[CUSTOMER][POSITIVE] It's a yes, yeah.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII] OK.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Do I need to put it to your attention?
[CUSTOMER][NEUTRAL] [PII], that is matter attention to only.
[AGENT][NEUTRAL] OK, is there anything else I can help with today?
[CUSTOMER][NEUTRAL] Yes, yes, I have last one more and may I have the call reference for this first?
[AGENT][NEUTRAL] It's my first name, last initial is [PII], today's date. Is this on the same patient?
[CUSTOMER][NEUTRAL] Yeah, give me 1 2nd please.
[CUSTOMER][NEUTRAL] 1 2nd, 1 2nd.
[CUSTOMER][NEUTRAL] I need to pull out that patient first.
[CUSTOMER][NEGATIVE] And I need to close this first.
[CUSTOMER][NEGATIVE] For the, I hope, I hope you understand for the HIPAA role, madam. We cannot go with the multiple pages.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, OK. I'm so sorry. There is a miscommunication over here. Mm, OK, 320.
[CUSTOMER][POSITIVE] Good
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, here we go with the next one and it is, uh, you want a member ID?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] It's 01835841.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK. The patient name is, it is [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And what's that date of service?
[CUSTOMER][NEUTRAL] Madam, your initial name is [PII].
[AGENT][NEUTRAL] Last initial is [PII].
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you have the date of service?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 1 2nd.
[CUSTOMER][NEUTRAL] The date of service is it is [PII].
[AGENT][NEUTRAL] And the build out?
[CUSTOMER][NEUTRAL] Um, the bill amount or the claim is.
[CUSTOMER][NEUTRAL] $3,801.
[AGENT][NEUTRAL] And then you need the received date and process date.
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] Uh, it was received on [PII].
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Process [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And
[AGENT][NEGATIVE] And that was denied. We need an explanation of benefits from the primary insurance.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm mhm. OK.
[CUSTOMER][NEUTRAL] OK, and call reference will be the same?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you. Have a great day.
[AGENT][NEUTRAL] OK, thanks for calling APL.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Bye.