AccountId: 011433970860
ContactId: 4cae5469-5486-4ec8-95ff-204f521f58c8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 358690 ms
Total Talk Time (AGENT): 154509 ms
Total Talk Time (CUSTOMER): 83477 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/4cae5469-5486-4ec8-95ff-204f521f58c8_20250327T17:45_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes, I'm calling from Mercy Hospital, Oklahoma. My name is [PII] and I'm needing to check a claim status.
[AGENT][NEUTRAL] OK [PII], you have one claim that you're needing to check claim status on, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes ma'am, I can help you with that and [PII], what is your callback number please?
[CUSTOMER][NEUTRAL] My direct line is [PII].
[AGENT][POSITIVE] Thank you and the member's policy number please.
[CUSTOMER][NEUTRAL] 01888607.
[AGENT][NEUTRAL] That was 3 8s that you said, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, thank you one moment please while I get the member's information pulled up.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] And you're welcome.
[AGENT][NEUTRAL] And any information [PII], that I do provide will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] What was the year? I'm sorry, what was the year?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK. OK, thank you.
[AGENT][NEUTRAL] Well, [PII], bear with me just one moment, my system.
[AGENT][NEUTRAL] Ha
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEGATIVE] It has stopped.
[AGENT][NEUTRAL] I will place you on a brief hold if that's OK, [PII].
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you so much. Just one moment, please.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, [PII], thank you so much for holding for me. OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII], what is the date of service and total bill amount for him, please?
[CUSTOMER][NEUTRAL] Uh, date of service is [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And total bill is 203, I'm sorry, $20,915.75.
[AGENT][NEUTRAL] 75 cents.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so yes, ma'am, this claim was received.
[AGENT][NEUTRAL] Uh, the receipt date on here will be 9-25-2024.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it was processed on 927-2024.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 351.
[AGENT][NEUTRAL] 1131.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] This claim was denied.
[AGENT][NEUTRAL] And the reason for the denial states these services were rendered after coverage was terminated.
[AGENT][NEUTRAL] This policy termed as of [PII] and there is no other active coverage beyond that point.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, OK, that would make sense. um, do you give out call reference?
[AGENT][NEUTRAL] And then.
[AGENT][NEUTRAL] Oh yes ma'am, no, I was just gonna say, and if you need a copy of this explanation of benefits [PII], now that you have the claim number, you should be able to print that directly from our portal if you go to um to [PII], don't put the [PII] it's just secured.
[CUSTOMER][POSITIVE] Oh, I'm sorry.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]. That's correct, secure. [PII]. Yes ma'am. Oh is there?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Yeah, OK, cool.
[CUSTOMER][POSITIVE] Luckily she did provide us with the insurance card so I got that off of that.
[AGENT][NEUTRAL] Uh, OK, yes, ma'am. So that's where you would go, and now that you have a claim number, you should be able to print that.
[CUSTOMER][POSITIVE] Awesome and yeah I guess all I need then is a call reference number if you give them.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, sure, you would use my name along with today's date.
[CUSTOMER][POSITIVE] Awesome thank you [PII] I appreciate your time.
[AGENT][POSITIVE] Well, you are certainly welcome. Yes, ma'am. It was my pleasure. And is there anything else, [PII], I can help you with?
[CUSTOMER][NEUTRAL] No, that was it.
[AGENT][POSITIVE] OK, well then, thank you again for calling APO have a great afternoon.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.