AccountId: 011433970860
ContactId: 4e07b698-6430-4204-9f25-79b36ca9361f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 326079 ms
Total Talk Time (AGENT): 102629 ms
Total Talk Time (CUSTOMER): 113919 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/4e07b698-6430-4204-9f25-79b36ca9361f_20250129T18:47_UTC.wav
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[AGENT][NEUTRAL] This is [PII]. How may I
[CUSTOMER][NEUTRAL] Good morning. I'm sorry, what was your name? You cut out.
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] [PII], good, um, good afternoon, Ms. [PII]. Yes, I am calling from Mercy Clinic Oklahoma Community. Wanting to check, um, we'll get a little bit more information about a denied claim. We got 4 patients.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, I can help you with your claims. Can you please give me your name and your callback number, please?
[CUSTOMER][NEUTRAL] Yes, ma'am. It's [PII].
[CUSTOMER][NEUTRAL] And my callback number is [PII].
[AGENT][NEUTRAL] OK, thank you, Ms. [PII]. And what is the patient's name?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, so her first name is [PII], so [PII]
[CUSTOMER][NEUTRAL] Last name is [PII]
[AGENT][NEUTRAL] Thank you. And what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] You're welcome. It is um [PII].
[AGENT][NEUTRAL] And her policy number, please?
[CUSTOMER][NEUTRAL] Yes, it is 02462791.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and what is the first date of service for [PII]?
[CUSTOMER][NEUTRAL] Yes, so the date of service was [PII].
[CUSTOMER][NEUTRAL] And the total charge amount was $206 even. I'm sorry, did you say?
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Gonna ask you for the charge amount, what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Um, so, actually, she has you guys down as her primary insurance.
[AGENT][NEUTRAL] OK, OK, let me look that claim up first.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, on uh this claim it was denied because for the patient's policy, it does not provide benefits for the treatment of conditions other than sickness or injury.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] That that.
[AGENT][NEUTRAL] And let me give you that claim number too.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] It's 350-5547.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 554-7. OK. And just to get it right, you said that for the patient's policy, you guys don't cover anything that doesn't have to do with um injury. Is that what you said?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] No, ma'am. Any conditions other than, so it, it only covers for sickness or injury.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 6
[CUSTOMER][POSITIVE] All righty then. Thank you so much. And do we have a reference number for the call?
[AGENT][NEUTRAL] Yes ma'am, you can use my name. It's [PII]
[AGENT][NEUTRAL] And today's date
[AGENT][NEUTRAL] And also just to let you know um.
[CUSTOMER][POSITIVE] All [PII].
[AGENT][NEUTRAL] This, this may help you with, with this insured. We're not her primary insurance, we're her secondary.
[AGENT][NEUTRAL] And this is a policy that only helps with deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so yeah, so, OK. OK.
[AGENT][NEUTRAL] It's, yes, it's limited, yes ma'am.
[CUSTOMER][POSITIVE] All [PII]. Well, yes, that helped me out tremendously. So thank you so much, Ms. [PII].
[AGENT][POSITIVE] Well, I'm glad. You're welcome. OK, Ms. [PII], you have a blessed day and thanks for calling APL.
[CUSTOMER][POSITIVE] OK. You have a good day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye-bye, ma'am.