AccountId: 011433970860
ContactId: 347c0753-c37d-40a7-9bf8-97b554d67243
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1231930 ms
Total Talk Time (AGENT): 359816 ms
Total Talk Time (CUSTOMER): 386787 ms
Interruptions: 4
Overall Sentiment: AGENT=0.1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/347c0753-c37d-40a7-9bf8-97b554d67243_20250210T19:49_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, um, hi, my name is [PII] and I'm calling to check on the status of a claim for a patient.
[AGENT][NEUTRAL] Sure, I can assist you with claim status, Ms. [PII]. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] And may I have the facility or doctor's office you're calling from?
[CUSTOMER][NEUTRAL] Yeah, it's SSM Health Medical Group and it also could be under Saints Medical Group.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Sure. That's gonna be 02131819.
[AGENT][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] One moment
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, it's [PII] Date of birth is [PII].
[AGENT][POSITIVE] Perfect, thank you. And may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, the, um, she's she's got a few claims here. Um, first date of service is [PII].
[CUSTOMER][NEUTRAL] Billed amount is $211.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me check that one first.
[AGENT][NEUTRAL] And for future, you can check claim status online through our website at [PII] and that's just optional.
[AGENT][NEUTRAL] Yeah, let me pull it.
[CUSTOMER][NEUTRAL] Yeah, you know, I, I tried um getting access.
[CUSTOMER][NEUTRAL] And it won't let me get past to the next um you know I, I picked my user name I did the password um put in my email and I confirmed it um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Phone number. I, I checked the, I have read and accepted the terms and then when I click on next it doesn't do anything.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hm.
[AGENT][NEGATIVE] So it doesn't let you go in and like it doesn't take you to the page to put your password and username and password again.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, because I'm trying to create, I'm trying to create the account, you know, so yeah, I did, I did my username I created a password. I did everything until the very end, but it won't let me when I click on the the box that says next.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] It doesn't do anything.
[AGENT][NEUTRAL] Do you have anything in red?
[CUSTOMER][NEUTRAL] Nope.
[AGENT][NEUTRAL] Nothing. Hmm, that's strange.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] It's OK. Um, let's do this, um, verbally and then we can try to get you in, OK? All right. Um, let's see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] It'd be great.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, I'm waiting on the EOB to pull up. OK, one moment.
[CUSTOMER][NEUTRAL] Oh sure. Sure.
[AGENT][NEUTRAL] All right. OK, so it looks like we processed the claim on [PII].
[AGENT][NEUTRAL] And um the claim was.
[AGENT][NEUTRAL] The claim was denied.
[AGENT][NEUTRAL] The reason for the denial is indicating that the policy does not provide physical benefits for physical therapy, occupational therapy, speech therapy, or any other types of therapies.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, the claim number for this, huh, go ahead.
[CUSTOMER][NEUTRAL] They don't
[CUSTOMER][NEUTRAL] Oh, go ahead, go ahead. That's fine.
[AGENT][NEUTRAL] The claim number for this date of service is 342.
[AGENT][NEUTRAL] 683 5.
[CUSTOMER][POSITIVE] Perfect, thank you.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Can you spell your first name?
[AGENT][NEUTRAL] Sure. My name is [PII]. Last initial [PII].
[CUSTOMER][POSITIVE] Perfect. Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and what is the next date of service?
[CUSTOMER][NEUTRAL] Alright, the next one is [PII].
[CUSTOMER][NEUTRAL] Total amount billed is $279.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] To another therapy one.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] And you said the total charge was how much?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] $279.
[AGENT][NEUTRAL] 99.
[AGENT][NEUTRAL] OK. So yes, um.
[AGENT][NEUTRAL] Waiting on the EOB to pull on.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEGATIVE] Looks like it's gonna be the same denial reason. I'm just looking for the processing.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, the process date is [PII].
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And the claim number is 342-6833.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome. I'm I'm ready for the next day of service.
[CUSTOMER][NEUTRAL] OK, that's [PII].
[CUSTOMER][NEUTRAL] Total bill is 279.
[AGENT][NEUTRAL] I'm waiting on the AOB.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so we processed on the same day, [PII], denied for the same reason.
[AGENT][NEUTRAL] And the claim number on this one is 342-6829.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] No money for the next date of service if you have another one.
[CUSTOMER][NEUTRAL] Oh, I sure do. Um, that's gonna be [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Total amount billed 200 and.
[CUSTOMER][NEUTRAL] $79.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] OK, so we processed this one on [PII]. It was denied for the same reason.
[AGENT][NEUTRAL] Now, the claim number on this one is 342-5064.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] I'm ready for the next one.
[CUSTOMER][NEUTRAL] Alright, the next one is.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 219 of 2024.
[CUSTOMER][NEUTRAL] Total amount billed is $325.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] OK, so this one is denied on [PII]. The reason is that office visits are not covered by the policy.
[AGENT][NEUTRAL] And the claim number is 3431804.
[CUSTOMER][POSITIVE] All right, thank you for that.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] That was
[CUSTOMER][NEUTRAL] 18
[CUSTOMER][NEUTRAL] OK. Um, next one is 618 of 24.
[CUSTOMER][NEUTRAL] Bill amount $253.29.
[AGENT][NEUTRAL] OK, so it looks like this film was processed [PII].
[AGENT][NEUTRAL] And the claim was denied stating office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 348.
[AGENT][NEUTRAL] 1204.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] All right, and then we have.
[CUSTOMER][NEUTRAL] 619.
[CUSTOMER][NEUTRAL] 2024, 325 is the amount billed.
[AGENT][NEGATIVE] This one is processed [PII] and it was denied office visits are not covered by the policy.
[AGENT][NEUTRAL] Claim number on this one is 348.
[AGENT][NEUTRAL] 1199.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK, that's all I have for her.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. And do you have any other for any other members or?
[AGENT][NEUTRAL] That's all.
[CUSTOMER][POSITIVE] Well, I do, but do you, do you wanna maybe assist me getting this, I mean, it's up to you. I, I do have more patience though.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] To check on.
[AGENT][NEUTRAL] OK, um, so for the online service center, um, let's, let's try to get you in. Let's see.
[AGENT][NEUTRAL] Let me go back to that page.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so what is the patient's account number that you used?
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEGATIVE] Jeez, I don't remember. Um.
[CUSTOMER][NEUTRAL] Because, let's see.
[CUSTOMER][NEUTRAL] I note
[CUSTOMER][NEUTRAL] All right, so that would have been for.
[AGENT][NEUTRAL] Or the tax ID I can probably use that.
[CUSTOMER][NEUTRAL] Oh yeah, tax ID is [PII].
[CUSTOMER][NEUTRAL] 0, wait a minute, I gotta get get another right one here.
[CUSTOMER][NEUTRAL] Here we go, um, [PII].
[AGENT][NEUTRAL] I'm searching on the data to see if I find it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Do you remember the username you chose?
[CUSTOMER][NEUTRAL] Yeah, um, I wrote it down here. Let's see, so that is gonna be.
[CUSTOMER][NEUTRAL] The username was [PII].
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Oh, they, no, my username is [PII]
[AGENT][NEUTRAL] You said um
[AGENT][NEUTRAL] OK, can you spell that one more time? I'm sorry.
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Any cabs letters or
[AGENT][NEUTRAL] Everything is in lower cases.
[CUSTOMER][NEUTRAL] Yes, lowercase.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK. Mhm.
[AGENT][NEUTRAL] OK, so no, it's not letting me. OK, so I guess we will have to just go ahead and start all over again. So let's go to the home page and click on new user.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK. Um, so, er, OK.
[CUSTOMER][NEUTRAL] And then I'm a medical provider, is what I.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then that
[CUSTOMER][NEUTRAL] OK, and then my tax ID, uh, let's see, [PII]. OK.
[CUSTOMER][NEUTRAL] Um, and then I'm gonna use this person here that we just went over, um.
[AGENT][POSITIVE] Yes, that'll be perfect.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that's gonna be P.
[CUSTOMER][NEUTRAL] CP 90545531.
[AGENT][NEUTRAL] Which number do you have?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, it was P as in Paul, 90545531.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 054550 OK so this one, OK.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, yeah, and OK, so then it brought me to my username.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, do I just
[CUSTOMER][NEUTRAL] Pick a different one, a different username? OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, all right.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, does it have to be, um, so many characters long or?
[AGENT][NEUTRAL] For the username, no. For the password, it's a little complex but not for the username. Mm.
[CUSTOMER][NEUTRAL] Does
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, OK, so do you, do I need to tell you what my username is?
[AGENT][NEGATIVE] No, no.
[CUSTOMER][NEUTRAL] OK, all right, um, so I'm gonna write that down so I.
[AGENT][NEUTRAL] Yeah, I was, mm mhm. Yeah, I was trying to do a search. That's why I asked for it to see if it will come up with that, but it didn't, so that's why I'm saying we probably need to just start all over again.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Gotcha, yeah. OK. All right. So let's see. Um,
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] And and we have to put in my like my mobile phone number is that?
[AGENT][NEUTRAL] Uh, it is not required. Mm, that is optional.
[CUSTOMER][NEUTRAL] It says text message.
[CUSTOMER][NEUTRAL] OK then I'm not, I'm not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] And it's already checked that I have read and accept the terms.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Now it says it's been successfully created.
[AGENT][POSITIVE] OK, perfect.
[CUSTOMER][POSITIVE] Yes, yes, that's all I needed to do was call.
[AGENT][NEUTRAL] Yeah, probably, yeah, probably time out or anything could have happened. It's sometimes it happens.
[CUSTOMER][NEUTRAL] 00, OK, yeah, that's.
[CUSTOMER][NEUTRAL] It could be, yeah, yeah, all right.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, well, great, and then you guys don't have um.
[CUSTOMER][NEUTRAL] Uh, call reference number you just go by your name, is that correct?
[AGENT][NEUTRAL] Yes, my name in today is [PII].
[CUSTOMER][POSITIVE] Same day. OK. All right, perfect. Well, thank you so much for helping me. Yeah, and there goes. I just received my confirmation. OK. Thank you so much for your help.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. Is there anything else I'm looking for today?
[CUSTOMER][POSITIVE] Uh, no, that's all I needed. Thank you.
[AGENT][POSITIVE] All right. You're welcome. Have a good day. Bye-bye. Thank you. Bye-bye.
[CUSTOMER][POSITIVE] Thank you. You as well. Bye.
[CUSTOMER][NEUTRAL] Yeah. Bye.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEGATIVE] You are on hold.