AccountId: 011433970860
ContactId: 3c3456b0-7fc8-4901-a70c-704acda19368
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 488880 ms
Total Talk Time (AGENT): 148471 ms
Total Talk Time (CUSTOMER): 131486 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/3c3456b0-7fc8-4901-a70c-704acda19368_20250128T17:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from Mercy Hospital checking on your claim status. Could you please spell out your name for me?
[AGENT][NEUTRAL] Yes, that's [PII] spelled [PII] And [PII], in case this call is, you're welcome. I can help you with claim status and in case this call is disconnected. May I have your callback number?
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Sure. It is [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number, please?
[CUSTOMER][NEUTRAL] Uh yes. Um, it is 01091926.
[AGENT][NEUTRAL] That was 01099126.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I'm sorry, it is 01091926.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And, and may I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], and date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And may I have the date of service and the bill amount?
[CUSTOMER][NEUTRAL] It is [PII] with the bill amount of $640 even.
[AGENT][NEUTRAL] Thank you. So it's for a data service of [PII], and that was for $64.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 6:40.
[AGENT][NEUTRAL] 6:14
[CUSTOMER][NEUTRAL] 640
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Username. Thank you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Let me just pull up
[AGENT][NEUTRAL] OK, I show this claim was received on
[AGENT][NEUTRAL] [PII], and it was also processed on the same day. Nothing was paid on this claim because the max has been met for this data service. Would you like the claim number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] The max benefit has already been met for this data service. Would you like the claim number?
[CUSTOMER][NEUTRAL] Uh yes.
[AGENT][NEUTRAL] That number is 351-1949.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 3151949.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, could you please send us a copy of UB through fax?
[AGENT][NEUTRAL] Yes, what is the fax number?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] And that number is [PII]?
[CUSTOMER][POSITIVE] Yes, you got it right.
[AGENT][NEUTRAL] And do I just need to make it to your attention?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I will get that faxed over to you. Is there anything else I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] On what day the max benefits have been met?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] On what date? Could you help me with the date, please?
[AGENT][NEUTRAL] For that date of service, [PII], for that data service has already been met for that data service.
[CUSTOMER][NEUTRAL] Yeah one moment.
[CUSTOMER][NEUTRAL] Which courts are denied
[AGENT][NEUTRAL] I'm sorry, can you repeat that?
[CUSTOMER][NEUTRAL] Yes, which codes are denied? Could you help me with those?
[AGENT][NEGATIVE] Nothing was paid on the entire claim. The whole facility claim was not paid.
[AGENT][NEUTRAL] They've met their max for the data service.
[CUSTOMER][NEUTRAL] Here we see only one claim for that date of service.
[AGENT][NEUTRAL] No, we received a previous claim from a different provider for that same data service.
[CUSTOMER][NEUTRAL] you
[CUSTOMER][NEUTRAL] From a different provider?
[AGENT][NEUTRAL] But this is, yes, but for this claim, this is the only claim we have on file for from this provider.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] So it was paid to a different provider, right? We won't accept those payments. I want you to send this claim back for the process.
[AGENT][NEUTRAL] It was previously met on a different claim.
[AGENT][NEUTRAL] We can't provide that information.
[AGENT][NEUTRAL] If you have questions in regards to the data service, you have to reach out to the patient in regards to that.
[CUSTOMER][NEUTRAL] Yes, I do understand, but uh this is an incorrect denial, right?
[AGENT][NEGATIVE] They've met their max for this data service, therefore, no additional benefits are payable.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So we can bill it to the patient.
[AGENT][NEUTRAL] We don't have any involvement in the handling of your remaining claim amount, and that's up to your determination.
[CUSTOMER][NEUTRAL] OK. On the same day the benefit has been met, [PII]. And what's the claim number for that?
[AGENT][POSITIVE] Yes, that is correct. Correct.
[AGENT][NEUTRAL] The claim number is
[CUSTOMER][NEUTRAL] Well I use the.
[AGENT][NEUTRAL] 351-1949.
[CUSTOMER][NEUTRAL] Uh, not this claim. I want the paid claim.
[AGENT][NEUTRAL] You have to obtain that information from the patient where I cannot provide you the information since the claim was not submitted by you. It's from a different provider.
[CUSTOMER][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] OK, what's the caller reference number?
[AGENT][NEUTRAL] It'll be just my name and that's [PII]. Is there anything else I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] And that is all I need.
[AGENT][NEUTRAL] OK. Well, thanks for calling ATU.
[CUSTOMER][NEUTRAL] Your name and today's date.
[AGENT][NEUTRAL] Again, that's [PII] and that's spelled [PII]
[CUSTOMER][NEUTRAL] OK. Only dinner, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Thank you so much, [PII]. Have a great day ahead.
[AGENT][POSITIVE] You're welcome. You too. Thank you for calling APL. Bye.