AccountId: 011433970860
ContactId: 354415b0-9944-476b-a6df-1697ccc7fd45
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1616900 ms
Total Talk Time (AGENT): 366419 ms
Total Talk Time (CUSTOMER): 354411 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/354415b0-9944-476b-a6df-1697ccc7fd45_20250530T18:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, yes, hi, [PII]. My first name is [PII] and my last name is [PII] calling you from the provider's office looking for claim status.
[AGENT][NEUTRAL] OK, I can help you with claim status, [PII]. May I please get your callback number, sir?
[CUSTOMER][NEUTRAL] Uh yes, the callback number is [PII].
[AGENT][NEUTRAL] Thank you. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] The patient's ID is [PII]. And the date of birth is [PII]. And the first name is [PII] and the last name is [PII], [PII].
[AGENT][POSITIVE] Thank you, sir.
[AGENT][NEUTRAL] Let me pull up that
[AGENT][NEUTRAL] Policy OK and can you give me the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Uh, yes, the data services [PII], I'm sorry, [PII] total charge is $1,648.50.
[AGENT][NEUTRAL] Uh thank you. And then what is the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Uh, one
[CUSTOMER][NEUTRAL] $1,099.74.
[AGENT][NEUTRAL] OK, and may I have the name of the provider, please?
[CUSTOMER][NEUTRAL] This is calling from San Francis Medical Center.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I look up this claim for you and I'll be right back sir.
[CUSTOMER][NEUTRAL] OK. You are on hold.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, [PII]. I do have the claim information for you.
[AGENT][NEUTRAL] The claim number is 3603533.
[AGENT][NEUTRAL] And the claim has been denied because we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] OK. And also, uh, this is, uh, can you also please check whether the patients are the COV information or not? Because as per from my end, uh, we already sent a letter to the patients because
[CUSTOMER][NEUTRAL] American public life is the only insurance we see.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] I don't have that information, but we are the secondary insurance. This policy is a gap insurance.
[AGENT][NEUTRAL] So it will never be the primary.
[CUSTOMER][NEUTRAL] Uh, when did the claim denied?
[AGENT][NEUTRAL] Uh, let me look that up for you, sir.
[AGENT][NEUTRAL] We received the claim on [PII] and processed it on [PII].
[CUSTOMER][POSITIVE] Thank you. Let's move to the next patient.
[AGENT][NEUTRAL] OK, and how many do you have?
[CUSTOMER][NEUTRAL] Uh, in total I have a few.
[CUSTOMER][NEUTRAL] 5 more claims.
[AGENT][NEUTRAL] OK, and what's the next patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Uh yes, the patient ID is 01631918. 1st name is [PII], last name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] OK, and then may I have the date of service and the charge amount?
[CUSTOMER][NEUTRAL] The data services 630-2024 total charges 18.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then may I have the charges after the primary paid?
[CUSTOMER][NEUTRAL] $964.22.
[AGENT][NEUTRAL] Thank you. And is it for the same facility?
[CUSTOMER][NEUTRAL] Uh yes, San Francis Hospital.
[AGENT][NEUTRAL] OK, I'm gonna put you on hold again. I'll be right back, [PII].
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you [PII] for holding for me. This claim number is 3597483, and it was denied for the same reason needing the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] So, uh, did you see, uh,
[CUSTOMER][NEUTRAL] Uh, uh, I mean, uh, could you please uh check uh which one is primary there?
[AGENT][NEUTRAL] Uh, I don't have that information.
[CUSTOMER][NEUTRAL] OK. Uh, when is the payment?
[AGENT][NEUTRAL] Uh, let me look.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] We received the claim on [PII] and processed it on [PII].
[CUSTOMER][POSITIVE] Uh, thank you. Let's move to the next.
[AGENT][NEUTRAL] OK, that
[AGENT][NEUTRAL] Can I get the policy number, name, and date of birth?
[CUSTOMER][NEUTRAL] Uh, yes, the patients.
[CUSTOMER][NEUTRAL] It's 02137652.
[AGENT][NEUTRAL] And what's the name and date of birth, please?
[CUSTOMER][NEUTRAL] Uh, yes, to patients, uh.
[CUSTOMER][NEUTRAL] So first name is uh [PII], last name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you sir and then what is the date of service?
[AGENT][NEUTRAL] And the charge amount?
[CUSTOMER][NEUTRAL] Net services at [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the total charges.
[CUSTOMER][NEUTRAL] Uh, $4,841 even.
[AGENT][NEUTRAL] OK, and charges after the primary?
[CUSTOMER][NEUTRAL] Uh, charges to the primary 205, I mean $250 even.
[AGENT][NEUTRAL] OK, and same facility?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, brief hold again. I'll be right back, [PII].
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Goodness gracious, all that wind blowing.
[AGENT][NEUTRAL] Ah
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, [PII], this is [PII] back with you again.
[AGENT][NEUTRAL] Um, the claim number for this one is 359-7902.
[AGENT][NEUTRAL] And this claim was denied because the explanation of benefits that was sent in does not say where the deductible co-pay or co-insurance has been paid.
[AGENT][NEUTRAL] From the primary.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh, I'm sorry, could you please repeat again.
[AGENT][NEUTRAL] Uh, we need an explanation of benefits showing that the deductible co-pay or co-insurance has been paid from the primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So when did the claim denied?
[AGENT][NEUTRAL] On
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and the fax number?
[AGENT][NEUTRAL] Fax number is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, if there is any time is fine.
[AGENT][NEUTRAL] We do not have one.
[CUSTOMER][POSITIVE] OK. Thank you.
[CUSTOMER][NEUTRAL] The annexations.
[AGENT][POSITIVE] OK, I'm ready.
[CUSTOMER][NEUTRAL] The next ideas.
[CUSTOMER][NEUTRAL] The next side is 4, I'm sorry, next side is 60801.
[AGENT][NEUTRAL] Uh, do you have another number? That's our payer ID number.
[CUSTOMER][NEUTRAL] Sure, I have one it is the policy ID. Can you try ID patient first name, last name, date of birth?
[AGENT][NEUTRAL] OK, what is the first name?
[CUSTOMER][NEUTRAL] Uh, the first name is.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. The last name is uh [PII].
[CUSTOMER][NEUTRAL] [PII] and the date of birth is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And it's [PII] And can you spell that last name for me again? There's a lot of wind blowing in the microphone, so it's hard for me to hear.
[CUSTOMER][NEUTRAL] OK. Uh, [PII].
[AGENT][NEUTRAL] OK, let me try to find it.
[AGENT][NEUTRAL] OK, I believe I have [PII] pulled up. May I please have the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Uh, 3720 [PII] total charge is $3,275 even.
[AGENT][NEUTRAL] OK and then charges after the primary?
[CUSTOMER][NEUTRAL] the primary is $323.45.
[AGENT][NEUTRAL] OK. And then is it for the same Saint Francis facility?
[CUSTOMER][NEUTRAL] A memorial Regional Medical Center.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold and look this one up. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] Thank you [PII] for holding for me. Let me give you the policy number.
[AGENT][NEUTRAL] It's 243-502-6.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And there is not a claim on file for that date of service.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, can I have the member effectively?
[AGENT][NEUTRAL] Yes, sir. It is.
[AGENT][NEUTRAL] [PII] and the policy is current.
[AGENT][NEUTRAL] And active.
[CUSTOMER][POSITIVE] Uh, thank you. Let's move to the next patient.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Oh so.
[CUSTOMER][NEUTRAL] Uh, the next set is uh 022-03907.
[AGENT][NEUTRAL] OK, and the name and date of birth, please?
[CUSTOMER][NEUTRAL] The patient's uh first name is [PII]. Last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, let me find them.
[AGENT][NEUTRAL] Alright, and then the data service and charge amount.
[CUSTOMER][NEUTRAL] Date of service uh [PII] and the total charge is $3,119 even.
[AGENT][NEUTRAL] And after the primary paid, what is the amount?
[CUSTOMER][NEUTRAL] Uh, $479 even.
[AGENT][NEUTRAL] OK, and the name of the facility?
[CUSTOMER][NEUTRAL] Uh, Saint Mary Hospital.
[AGENT][NEUTRAL] OK, let me look him up. I'm gonna put you on hold again. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you [PII] for holding for me.
[AGENT][NEUTRAL] So this claim number is 359-7908.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] The claim was paid $479.
[AGENT][NEUTRAL] With check number 2042795.
[AGENT][NEUTRAL] It was paid on, let me look.
[AGENT][NEUTRAL] It was paid on [PII].
[AGENT][NEUTRAL] To Saint Mary's Hospital.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And how about the uh check clear date?
[AGENT][POSITIVE] It's not cleared yet. It's still outstanding. It's just sent.
[CUSTOMER][NEUTRAL] So do I need to allow some more time?
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] And there is no denial on the claim, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, thank you. Let's move to the last patients.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEGATIVE] The lost patience, ideas.
[CUSTOMER][NEUTRAL] 02435030.
[AGENT][NEUTRAL] And the name and date of birth, please?
[CUSTOMER][NEUTRAL] Uh, being patient. First name is uh [PII]. Last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And then what is the date of service?
[AGENT][NEUTRAL] And the charge amount?
[CUSTOMER][NEUTRAL] There
[CUSTOMER][NEUTRAL] [PII]. Total charge is $5,416 and
[CUSTOMER][NEUTRAL] 90 cents.
[AGENT][NEUTRAL] And then the charges after the primary paid?
[CUSTOMER][NEUTRAL] After the primary $540.58.
[AGENT][POSITIVE] Thank you. And then also the name of the facility.
[CUSTOMER][NEUTRAL] This is from the uh Saint Mary Hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, quick hold again, [PII], I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you [PII]. I have this claim information for you.
[AGENT][NEUTRAL] The claim number is 359-716-7.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] The claim was paid $540.58.
[AGENT][NEUTRAL] With check number 2,042,880.
[AGENT][POSITIVE] That check was issued on [PII] and it is still outstanding.
[CUSTOMER][NEUTRAL] Let's
[AGENT][NEUTRAL] It's paid to Saint Mary's Hospital.
[CUSTOMER][NEUTRAL] And the address is it.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] But yeah, it's already more than the 14 days from the issue date. So is it possible to reissue the check or do I need to wait?
[AGENT][NEUTRAL] You need to wait.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] so sorry.
[CUSTOMER][NEUTRAL] OK, so, uh.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][POSITIVE] Uh thank you so much and do you have any call reference number?
[AGENT][NEUTRAL] Yes sir, you can use my name [PII] and today's date.
[CUSTOMER][POSITIVE] OK. OK, thank you so much. That's all I need. Um, have a very blessed day.
[AGENT][POSITIVE] You have a blessed day too, [PII], and a wonderful weekend. Thank you for calling APL sir.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][POSITIVE] Thank you so much, yeah.
[CUSTOMER][NEUTRAL] Bye.