AccountId: 011433970860
ContactId: 3c7a9e81-86d7-4c0b-ba42-5d1e91a24ea2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 376970 ms
Total Talk Time (AGENT): 138774 ms
Total Talk Time (CUSTOMER): 110447 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/3c7a9e81-86d7-4c0b-ba42-5d1e91a24ea2_20250522T20:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes ma'am, this is [PII] with Creek Nation Hospital and Clinics, and I am trying to get claim status. I went online and unfortunately I don't have a claim number to put in.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] To check claim status so I can't check claim status, is there any way you can help me?
[AGENT][NEUTRAL] Yeah, I can help you with claim status. Uh, [PII], can I get a good callback number in case we get disconnected?
[CUSTOMER][POSITIVE] Great.
[CUSTOMER][NEUTRAL] Yes ma'am, [PII].
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] 01
[CUSTOMER][NEUTRAL] 823419
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Can I get you to verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] And what was the date of service?
[CUSTOMER][NEUTRAL] I have several.
[CUSTOMER][NEUTRAL] Um, [PII] of 24.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] OK, and what's the other one?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] 7:15 of 24.
[CUSTOMER][NEUTRAL] 716 of 24.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm gonna let me do because I have probably 20.
[AGENT][NEUTRAL] OK. Let's start one by one.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, so 614 of 24.
[AGENT][NEUTRAL] OK, let me look.
[AGENT][NEUTRAL] OK, and what was the provider's name?
[CUSTOMER][NEUTRAL] Uh, it's either Creek Nation Hospital and Clinics or the individual provider is [PII].
[AGENT][NEUTRAL] OK, I'm not showing one with that provider name for that date of service.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To be under any other name?
[CUSTOMER][NEUTRAL] Uh, let me look at the, let me look at the claim, uh, let's see.
[CUSTOMER][NEUTRAL] Oh Morgi Indian Health Clinic.
[AGENT][NEUTRAL] OK, OK, that's what I have.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Just wanna make sure in case they did, you know, see multiple doctors at the same time.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And would you like the claim number?
[CUSTOMER][NEUTRAL] Uh, yes ma'am, please.
[AGENT][NEUTRAL] OK, the claim number.
[AGENT][NEUTRAL] It's 347.
[AGENT][NEUTRAL] 97.
[AGENT][NEUTRAL] 03.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Let's see, I'm showing that that was denied. Let me see why.
[AGENT][NEUTRAL] OK, it looks like we need.
[AGENT][NEUTRAL] The major medical insurance provider, so benefits are only payable if the major medical insurance provider provides benefits. So if this claim was paid by major medical, we need the explanation of benefits showing that they were paid, um, because this is secondary gap insurance, so the primary or the major medical has to pay first, and then this picks up the rest. So if major medical denies the claim, this denies the claim.
[CUSTOMER][NEUTRAL] Sign
[CUSTOMER][NEUTRAL] Does that mean if it's.
[CUSTOMER][NEUTRAL] OK, so if it was applied to the deductible, would you guys pay?
[AGENT][NEUTRAL] Right, this policy pays for co-insurance, co-pay, and co-deductible. So yes, it would go towards that.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so we just need to send in the.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] You'll be in the claim and where would, where would we send that to?
[AGENT][NEUTRAL] Um, you can either upload it online or you can mail it or fax.
[CUSTOMER][NEUTRAL] Uh, fax. What's the fax number?
[AGENT][NEUTRAL] Which ones? Thanks, OK.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII] and you'll do attention claims department.
[CUSTOMER][NEUTRAL] 3
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] So with with having this one claim, can I look up all her claims online or am I gonna have to have a claim number for each data service?
[AGENT][NEUTRAL] You should be able to do it because when you um
[AGENT][NEUTRAL] Whenever you fill out, right, because you'll need you'll use the patient account number not not their policy number so whenever you go in you'll use the patient account number so they should all go towards the same one as long as she has the same account number.
[CUSTOMER][NEUTRAL] I just need one to get in, don't it, uh huh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, all right, thank you very much I will try that.
[AGENT][NEUTRAL] Alright, is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Uh, no, ma'am, thank you very much I appreciate it.
[AGENT][POSITIVE] OK, thank you for calling APL and have a great day.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye.