AccountId: 011433970860
ContactId: 32471712-ef8d-450f-ac41-5202df95575a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 681630 ms
Total Talk Time (AGENT): 140123 ms
Total Talk Time (CUSTOMER): 106666 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/32471712-ef8d-450f-ac41-5202df95575a_20250220T20:55_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you? Excuse me.
[CUSTOMER][NEUTRAL] Hi. So this is [PII] calling from Mercy Hospital looking for a claim status.
[AGENT][NEUTRAL] Sure, I can assist you with claim status. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Policy number 02018413.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] And what's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the day of service and the amount of the claim?
[CUSTOMER][NEUTRAL] The service, [PII] and the bill amount $389 even.
[AGENT][NEUTRAL] [PII], the amount of 389.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright
[AGENT][NEUTRAL] And for future you can check claim status online through our website at [PII] and that's just optional. And let me pull this ELV one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, for that portal, I have to register, right? I need, I need PayTM number.
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] I'm sorry, can you repeat?
[CUSTOMER][NEUTRAL] I'm asking about the portal you told me, right?
[CUSTOMER][NEUTRAL] For that, I have to register and need a paid claim number.
[CUSTOMER][NEUTRAL] Like for the tax.
[AGENT][NEUTRAL] Oh yes, yeah, for the portal, yes, mhm, right.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, so it looks like we processed the claim on [PII].
[AGENT][NEUTRAL] And the claim was denied. The reason for this denial is
[AGENT][NEUTRAL] The policy does not provide any benefits for expenses incurred for a pregnancy of a dependent child.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] Yeah, you're saying uh the services what we bill it does not cover, does it?
[AGENT][NEGATIVE] It is not covered, right.
[CUSTOMER][NEUTRAL] Uh, may I have the claim number?
[AGENT][NEUTRAL] The claim number is 3248553.
[CUSTOMER][NEUTRAL] Is it possible to fax that EOB?
[AGENT][NEUTRAL] What is the fax number?
[CUSTOMER][NEUTRAL] Yes
[AGENT][POSITIVE] I'm ready for the vaccine.
[CUSTOMER][NEUTRAL] Fax number 585, yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Repeat it, I'll repeat that again. 5854409493.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, that
[CUSTOMER][NEUTRAL] A [PII].
[AGENT][NEUTRAL] OK, so that's 8, I'm sorry, 5854409493.
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] OK, do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me. OK, I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I'm gonna help you with today?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, I have one more client for the same patient, the same provider.
[AGENT][NEUTRAL] OK, what is this?
[CUSTOMER][NEUTRAL] I hope that claim also related to the yeah sorry.
[AGENT][NEUTRAL] Go ahead, go ahead.
[CUSTOMER][NEUTRAL] Now, that claim also related to the pregnancy code. Hopefully that claim also made for an on services. I need a year before the claim after the claim number.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Um, and what is the date of service?
[CUSTOMER][NEUTRAL] OK the service [PII] and the bill amount $168 even.
[AGENT][NEUTRAL] OK, so this one was denied stating that office visits are not covered and you said you need a copy of this one as well?
[CUSTOMER][NEUTRAL] Yes, may I have the dinner date and claim number?
[AGENT][NEUTRAL] One moment, let me pull the image.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so, uh, the claim was processed on [PII]. The claim number is 3253211.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Mm thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you say you also need a copy of this one?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. One moment.
[AGENT][POSITIVE] All right. I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I'm gonna help you with today?
[CUSTOMER][NEUTRAL] I can set up for you. May I have the call reference number for this call?
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's state if you will.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] That's all for you. Thank you so much. Have a wonderful day.
[AGENT][POSITIVE] You're welcome. You as well, and thank you for calling APL. Bye-bye, Mr. [PII].