AccountId: 011433970860
ContactId: 3ee997d1-358d-47eb-a80b-165c8121419a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 844659 ms
Total Talk Time (AGENT): 252551 ms
Total Talk Time (CUSTOMER): 157712 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/3ee997d1-358d-47eb-a80b-165c8121419a_20250429T18:44_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office checking on a claim status.
[AGENT][NEUTRAL] Sure, I can assist you with claim status. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[CUSTOMER][NEUTRAL] [PII] and the extension will be [PII].
[AGENT][NEUTRAL] [PII], is that correct?
[CUSTOMER][NEUTRAL] Hello? Uh, sorry, I missed you.
[AGENT][NEUTRAL] OK. Um, you said the callback number is [PII]?
[CUSTOMER][POSITIVE] Yeah, that's correct.
[AGENT][NEUTRAL] OK. Thank you. And may I have the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Sure. It's Holy Cross Hospital.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's 02496781.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Patient name is [PII]. The date of birth is [PII].
[AGENT][NEUTRAL] OK, perfect. Thank you. What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Data services [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the total charges here is
[CUSTOMER][NEUTRAL] 12337 3.24.
[AGENT][NEUTRAL] OK, so that is [PII], the amount of $123,373.24.
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you. Let me see if I can find this claim for you. And for the future, you can check claim status online through our website at [PII] and that's just optional.
[AGENT][NEUTRAL] And let me pull this EOB one moment.
[AGENT][NEUTRAL] I'm still waiting on the UB OK. One moment.
[CUSTOMER][POSITIVE] Take your time.
[AGENT][POSITIVE] Mm thank you.
[AGENT][NEUTRAL] OK, looks like we processed the claim on [PII] and it looks like we're waiting um.
[AGENT][NEUTRAL] Let's see, we're waiting information from the employer um to confirm eligibility. So once we receive that information, the claim will be reprocessed.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Uh, you have to get the information from the employee employee, right? E employee or the employee?
[AGENT][POSITIVE] Correct. Yes.
[CUSTOMER][NEUTRAL] Uh, sorry, no, I'm asking whether it's from employee or the employer.
[AGENT][NEUTRAL] Employer
[CUSTOMER][NEUTRAL] Yeah, got it. Uh, could you provide me the call, uh, claim number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, sure, yes. Um, the claim number is 357-827-2.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And how many claims you can assist me with?
[AGENT][NEUTRAL] How many are you gone?
[CUSTOMER][NEUTRAL] Uh, I have another one to go.
[AGENT][NEUTRAL] How many?
[CUSTOMER][NEUTRAL] I have another one to go.
[AGENT][NEUTRAL] Just one more.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh yeah, that's fine.
[AGENT][NEUTRAL] OK. What's the next policy?
[CUSTOMER][NEUTRAL] Uh, actually, what is, uh, in this claim, it's a split claim. I have a date range here and they are [PII].
[CUSTOMER][NEUTRAL] Uh, I have 8 data service for this.
[AGENT][NEUTRAL] Do you have a data service for the same member?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, it's fine. We're the same member. Is it still with [PII] or is it a different member?
[CUSTOMER][NEUTRAL] Uh, sorry, this claim is for us.
[CUSTOMER][NEUTRAL] Different member.
[AGENT][NEUTRAL] OK, go ahead with the policy number.
[CUSTOMER][NEUTRAL] Yeah, the policy number is 01699961.
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima number 7.
[AGENT][NEUTRAL] All right. And what is the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] It's [PII] and the date of date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And are these gonna be consecutive days or is this separate for each day?
[CUSTOMER][NEUTRAL] Uh, actually, the date starts on [PII] and ends on [PII], and I have, uh, claims the charges for different dates from [PII].
[AGENT][NEUTRAL] Do you know if they send um like a claim for each day or was there all bundle in one claim?
[CUSTOMER][NEUTRAL] Yeah, I have a date here first claim date of services for [PII].
[AGENT][NEUTRAL] OK, how much is that one for?
[CUSTOMER][NEUTRAL] It's $312 even.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mr. [PII], is that correct? [PII]?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Let me.
[AGENT][NEUTRAL] Bear with me just a second, I think there's a different policy. There's not that 11 moment.
[AGENT][NEUTRAL] Alright, let me pull this ERB. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm still waiting on the EOB, OK.
[AGENT][NEUTRAL] All right. So it looks like uh it was processed and denied. [PII] indicating that kneology, speech, or occupational therapy are not covered.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Can I go with the next date?
[AGENT][NEUTRAL] What is the next date?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] How much is the total charge on that one?
[CUSTOMER][NEUTRAL] $618 even.
[AGENT][NEUTRAL] OK, so that one is denied with the same reason. Do you need the claim numbers on these?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, um, so do you need the claim number for the first one?
[CUSTOMER][NEUTRAL] Yeah, go ahead.
[AGENT][NEUTRAL] OK, so the [PII], the claim number was 352-8961.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] So it's, and then [PII] is claim number 3,570,100 and it's the same denial, which is kineology, speech, or occupational therapy are not covered.
[AGENT][NEUTRAL] What's the next date of service?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, so it's gonna be the same denial. This was for [PII] as well, correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, the claim number is 352-8960.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] OK, what's the next date of service?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Sorry, that's the one which I gave right now, right?
[AGENT][NEUTRAL] Yeah, that's the one we did, yeah, mhm.
[CUSTOMER][NEUTRAL] Yeah, it's [PII], next day.
[CUSTOMER][NEUTRAL] $306 even.
[AGENT][NEUTRAL] OK, let me see this one.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] once
[AGENT][NEUTRAL] Bear with me because it looks like this one was paid, but I just need to check what is the difference because the rest are all denied for the same reason. One moment.
[CUSTOMER][NEUTRAL] you know.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm still waiting on the paperwork. Yes, I'm waiting on the paperwork. One moment.
[CUSTOMER][NEUTRAL] And hello?
[CUSTOMER][NEUTRAL] Yeah, yeah, and what is like, uh, I, I reviewed this claim and this is not related to guy you know actually it's related to cerebral.
[CUSTOMER][NEUTRAL] And that's related to brain, right?
[AGENT][NEUTRAL] Mm, yeah, but this is um the therapy. If it's physical therapy, we cover physical therapy, but if it's kindology, speech or occupational therapy, those are not covered.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. OK. So it looks like this one is physical therapy, so it did pay the $20 for the physical therapy.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Mhm.