AccountId: 011433970860
ContactId: 33d3bb4b-5617-4767-9c8a-68690bc44670
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 610200 ms
Total Talk Time (AGENT): 283579 ms
Total Talk Time (CUSTOMER): 164585 ms
Interruptions: 4
Overall Sentiment: AGENT=1.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/33d3bb4b-5617-4767-9c8a-68690bc44670_20250421T13:58_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] with um Christopher Rural Health.
[AGENT][POSITIVE] Yes, ma'am. How can I help you?
[CUSTOMER][NEUTRAL] Clinic and I'm calling regarding a um a denial.
[CUSTOMER][NEUTRAL] I need further information on it.
[AGENT][NEUTRAL] OK, your name
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Any further information on the denial of a claim, is that correct?
[AGENT][NEUTRAL] Hello, [PII], can you hear me?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yes I can.
[AGENT][NEUTRAL] Did you say that you were needing information?
[AGENT][NEUTRAL] OK. Did you say you were needing information on a denied claim, is that?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes ma'am, I can help you with that. What is your call back please?
[CUSTOMER][NEGATIVE] You keep cutting in and out. I'm sorry.
[CUSTOMER][NEUTRAL] My call back is [PII]. That's my direct line.
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] Uh, policy number is D43411.
[CUSTOMER][NEUTRAL] 356.
[AGENT][POSITIVE] OK thank
[AGENT][NEUTRAL] Thank you, but [PII], that is not an APO policy number. That's a benefit number. Were you trying to reach 90 degree benefits or APL?
[CUSTOMER][NEUTRAL] Well, APL is the one who who sent us the um the claim.
[AGENT][NEUTRAL] OK, so on our explanation of benefits, there is a policy number.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's the number that I need for APL. I can't access.
[CUSTOMER][NEUTRAL] Oh, I'm sorry, um 02.
[CUSTOMER][NEUTRAL] 501002.
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And any information honey that I do provide for you would be a verification of benefits and not a guarantee of payment. What is your patient?
[CUSTOMER][NEUTRAL] Patient's name is [PII].
[AGENT][NEUTRAL] Name and their date of birth?
[CUSTOMER][NEUTRAL] I'm sorry, [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] I guess
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And tell me again, any information provided would be a verification of benefits and not a guarantee of payment. What is the data service and total bill amount, please?
[CUSTOMER][NEUTRAL] Date of service is [PII]. Billed amount is $150.
[CUSTOMER][NEUTRAL] I don't
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] OK, and do you have the claim number that you're calling in regards to?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Claim number is 3563986.
[AGENT][NEUTRAL] 356-3986. OK. Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so yes, I, I do have that claim um information pulled up and I can see that it was denied. One of the reasons for the denial on here states.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, so one of the remarks indicates that the premium for this service date was not received, therefore benefits are not payable. Also there is another remark regarding.
[AGENT][NEUTRAL] A be notice. Give me just a moment to pull some additional information on that, please.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, ma'am, can you hear me?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I can't now what what did you what did you say?
[AGENT][NEGATIVE] One of the denial remarks is related to premium, not having been received and the other remark has to do, um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Has to do with the fact that we're unable to accept the assignment of benefits for the claim filed due to a discrepancy reported to us by the IRS that is in combination with the name and the taxpayer identification number.
[AGENT][NEUTRAL] Please visit the IRS website for additional information on how to resolve this issue.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And stop back up withholding. On this issue has been resolved, please send APLA copy of the updated information.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] And do you know if this has been resolved?
[AGENT][NEUTRAL] I do not, but I can send an email to the.
[AGENT][NEUTRAL] To our um
[AGENT][NEUTRAL] Person that would contact you regard.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Regarding that, um, what is your full name to last name?
[CUSTOMER][NEUTRAL] Uh [PII]
[CUSTOMER][NEUTRAL] Last name last name first initial is [PII] hello? hello.
[AGENT][NEUTRAL] Yes, ma'am. OK, are, are you getting some kind of sound on your end because I keep hearing you say hello, hello.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] I, you're not there like, like you, you cut out like you're gone.
[AGENT][NEUTRAL] OK, I'm not sure, [PII], what, what, why that is happening. I do apologize. What I can do is I can take down your information and send an email to the person that would work with that type of scenario here at APL and I ask them to give you a call. What is the uh.
[AGENT][NEUTRAL] Provider facility name that you're with or the group?
[CUSTOMER][NEUTRAL] Um, it's Christopher Rule Health, Christopher Rule Health.
[AGENT][NEUTRAL] Business name?
[CUSTOMER][NEUTRAL] Planning Corp.
[AGENT][NEUTRAL] Rural like
[CUSTOMER][NEUTRAL] I'll go ahead and
[AGENT][NEUTRAL] OK, hold on. It's rural. Is it like R U R A L?
[CUSTOMER][NEUTRAL] Like, like a rural area.
[AGENT][NEUTRAL] OK, are you?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] A L, OK. So Christopher.
[AGENT][NEUTRAL] For all, and what is the rest of it?
[CUSTOMER][NEUTRAL] It's Christopher Rural Health Planning Corp.
[CUSTOMER][NEUTRAL] And I will also um.
[CUSTOMER][NEUTRAL] Give the letter to our credentialing.
[CUSTOMER][NEUTRAL] And have her contact them.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Because I mean we haven't had any issues with this.
[AGENT][NEUTRAL] OK, and would you
[AGENT][NEUTRAL] OK, and what is your email address, [PII]?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Um, just a minute, I'll have to look at that.
[CUSTOMER][NEUTRAL] Um, it is.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] J O I N E R.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'm just gonna repeat that back. [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK, and then your phone number, the [PII] is your direct number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so yes ma'am, I.
[AGENT][NEUTRAL] We'll send um an email regarding this.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] So [PII], I will send an email regarding this to have someone reach out to you all.
[CUSTOMER][POSITIVE] OK perfect thank you.
[AGENT][POSITIVE] OK. Well, you're certainly welcome. Again, is there anything else that I can help you with this morning?
[CUSTOMER][NEUTRAL] Uh, no, that's it.
[AGENT][POSITIVE] OK, well, thank you so much again for calling APL. In the future, I just wanna go ahead and give you our website where if you ever need a copy of the next.
[AGENT][NEUTRAL] Explanation of benefits for us you should be able to by going to our portal at [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, well, again, any.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Anything else I can help you with this morning?
[CUSTOMER][POSITIVE] Uh, no, that'd be it, thank you.
[CUSTOMER][POSITIVE] You have a good day.
[AGENT][POSITIVE] OK. Well, you're welcome and thank you again for calling. Yes, ma'am. You too and thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you bye.
[AGENT][POSITIVE] You're welcome