AccountId: 011433970860
ContactId: 52116d78-50ac-415b-bf11-727170530916
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 527989 ms
Total Talk Time (AGENT): 224858 ms
Total Talk Time (CUSTOMER): 138414 ms
Interruptions: 4
Overall Sentiment: AGENT=1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/52116d78-50ac-415b-bf11-727170530916_20250430T16:45_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from Baptist Memorial Hospital. I'm looking for a claim status today.
[AGENT][NEUTRAL] OK, [PII], you have one claim that you're needing status for, is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 2
[AGENT][NEUTRAL] You have 1 or 2 claims.
[CUSTOMER][NEUTRAL] Two claims.
[AGENT][NEUTRAL] OK, are your clients for the same member or different members?
[CUSTOMER][NEUTRAL] No, different, different patients.
[AGENT][NEUTRAL] OK. Yes, I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. So [PII], you will use my name that I gave you along with today's date as each of your call reference numbers. Also any information that is provided for you will be a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And lastly, if we do have the claims on file [PII] and you need a copy of the explanation of benefits, you should be able to print that by going to our portal which is located at secured.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is your first patient's policy number?
[CUSTOMER][NEUTRAL] 982-081.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] And what is the date of service? I'm sorry, what is your patient's name please and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then what is the date of service and total bill amount please?
[CUSTOMER][NEUTRAL] [PII] and the total bill is $35,951.40 41 cents.
[AGENT][NEUTRAL] OK, so that was data service [PII] and you said the total bill amount is 35,951 dollars.41 cents, is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect dressing.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I do show that this claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 356.
[AGENT][NEUTRAL] 5963.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] This claim was denied.
[AGENT][NEUTRAL] And the reason for the denial states benefits payable under this certificate are limited to those outlined on the schedule of benefits. This is not a covered loss under the plan. Therefore, no amount is payable for this expense.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. So we can bill to this patient, right? So we can bill this claim to the patient.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We do not determine patient responsibility, [PII], that would be up to the provider.
[CUSTOMER][NEUTRAL] OK, let's have.
[CUSTOMER][NEUTRAL] Mm, not covered. So actually I have checked in the portal, so I didn't see any EOB there. So it will take time to post EOB in the portal.
[AGENT][NEUTRAL] Um, it should be there, so when you use that claim number you were not able to locate it?
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] OK, actually, we didn't receive any EOB so I tried with the patient's name and the date of birth. So, so I will try out.
[AGENT][NEUTRAL] OK, try with that claim number that I just, yeah, try with the claim number they're making some updates to the portal currently, [PII].
[AGENT][NEUTRAL] And typically if someone can't locate it with the other information if they have the claim number then it will pull up for them.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Are you able to see if you can access it?
[CUSTOMER][POSITIVE] OK. Thank you, [PII].
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, you, you're saying something.
[AGENT][NEUTRAL] No, I was just saying it try it with using the claim number.
[AGENT][NEUTRAL] To see if that will allow you to.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To pull it up.
[CUSTOMER][NEUTRAL] OK, [PII]. So if you're ready, we can move with another patient.
[AGENT][NEUTRAL] OK, just one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, and I'm ready for the next policy number.
[CUSTOMER][NEUTRAL] 982-519
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], and the date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the date of service and total bill amount please?
[CUSTOMER][NEUTRAL] [PII] and the total bill is $2,369 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, so this claim was also received. The received date was [PII].
[AGENT][NEUTRAL] It was processed on the same date, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3546763.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] This claim was also denied.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the reason for the denial states these services were rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The termination date on this policy is the term date on this policy is [PII].
[CUSTOMER][NEUTRAL] OK. So do you have any other active policy information, [PII]?
[AGENT][NEUTRAL] No, sir, not with our company.
[AGENT][NEUTRAL] There's no other coverage beyond that time frame with APL.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK. Thank you, thank you, [PII], for the information you provided. That's all I have for today. Nice talking to you. Bye for now.
[AGENT][POSITIVE] You're welcome. OK, well, it was nice speaking to you too, [PII]. So if that's all I can help you with, thank you for calling APL, and I hope you have a great day.
[CUSTOMER][NEUTRAL] Yeah, same too, bye.
[AGENT][POSITIVE] Thank you, bye bye.