AccountId: 011433970860
ContactId: 538f072c-bae8-4da2-baf3-f169caad4ea7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 565780 ms
Total Talk Time (AGENT): 191386 ms
Total Talk Time (CUSTOMER): 142488 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/538f072c-bae8-4da2-baf3-f169caad4ea7_20250417T17:22_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, my name is [PII] calling from Rotech provider office. I'm looking for claim status for the data service.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the um claim status. Did you say your name was [PII]?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes, to you. Last name is [PII].
[AGENT][NEUTRAL] Alright, and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. [PII].
[CUSTOMER][NEUTRAL] And the extension is [PII].
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today, [PII]?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And, um, may I have, oh, go ahead. I'm sorry.
[CUSTOMER][NEUTRAL] That number ID.
[CUSTOMER][NEUTRAL] Sure. Go ahead. Go ahead. OK, go ahead.
[AGENT][NEUTRAL] I was asking how many claims you had in total.
[CUSTOMER][NEUTRAL] Only one claim.
[AGENT][NEUTRAL] OK, may I have the member's policy number?
[CUSTOMER][NEUTRAL] 10248.
[CUSTOMER][NEUTRAL] 786 6
[CUSTOMER][NEUTRAL] Again, 02487866.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Again.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you so much for holding, [PII]. I apologize for that wait. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Last name is [PII], first name is [PII], and DOB [PII]. It's a [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bills for the claim?
[CUSTOMER][NEUTRAL] It was [PII].
[CUSTOMER][NEUTRAL] One moment on the bill amounts.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Bilderman's $283.38.
[AGENT][NEUTRAL] $283.38. OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So Camden Medical Supply ANC.
[AGENT][NEUTRAL] I'm sorry, what's the name of the facility?
[CUSTOMER][NEUTRAL] Is it Camden Medical supply INC or it's American Medical renal and Sales?
[AGENT][NEUTRAL] What's the tax ID?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. For some reason, it came over Rotech Healthcare. Um, so I'm showing that we
[CUSTOMER][NEUTRAL] Yes, uh you mentioned that.
[AGENT][NEUTRAL] Alright, I'm showing that we received the.
[CUSTOMER][NEUTRAL] He also mentioned your.
[AGENT][NEUTRAL] OK, I'm showing that we received the claim on [PII].
[CUSTOMER][NEUTRAL] So you go ahead.
[AGENT][NEUTRAL] The claim number is 3554145.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Um, let me see why. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We are awaiting eligibility information from the employer. Once we receive it, we will continue um processing. So this claim is on hold until the employer confirms the eligibility, and then once we receive that, we'll we'll automatically continue processing.
[CUSTOMER][NEUTRAL] Thank you. Uh, could you repeat the reason I need to type?
[AGENT][NEUTRAL] Um, we're awaiting
[AGENT][NEUTRAL] Eligibility from employer.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] One moment. Mm.
[CUSTOMER][NEUTRAL] OK, you are waiting eligibility for employee, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. What action do I need to take for this claim? Could you explain to me?
[AGENT][NEUTRAL] Um, there's really nothing for you to do, um, uh.
[AGENT][NEUTRAL] The member can reach out to the um employer if they like, but there's really nothing to do at this point. The employer is aware, we do the eligibility all the time and once received, we'll just go ahead and continue processing, um.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] The only thing to do would be to reach out to the employer.
[CUSTOMER][NEUTRAL] OK, thank you. Uh, I need to call reference and your name is the last issue.
[AGENT][NEUTRAL] Sure, so there's no call reference number, but my name is [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Call reference name is today's date, right?
[AGENT][NEUTRAL] Yes, my name is today's date.
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII]. Have a great day. Thank you for assisting with me.
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEGATIVE] I have one more data service for the same patient. This is all the same denied.
[CUSTOMER][NEUTRAL] It's a [PII] day service.
[AGENT][NEUTRAL] The total bills?
[CUSTOMER][NEUTRAL] So $359.66.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, [PII]:21, 2024.
[AGENT][NEUTRAL] OK, did you need like the claim number and everything, or you just, because it's the same denial reason. Did you need the date we received it in process?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm asking, did you still need the claim information?
[CUSTOMER][NEUTRAL] Yes, I need the claim information.
[AGENT][NEUTRAL] OK, so it was received on [PII]?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And on [PII], the claim was denied, waiting for eligibility.
[CUSTOMER][NEUTRAL] Same reason, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. How many days do I need to wait?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, before you said that we are, you are waiting for eligibility from employer. It's like how many days?
[AGENT][NEGATIVE] There's no turnaround. We don't, we don't provide them with a turnaround. Once they send it to us, we continue processing.
[CUSTOMER][NEUTRAL] OK, you want eligibility for my employer, right?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] You want uh eligibility need from employee, right?
[AGENT][NEUTRAL] Yes, we need um eligibility from the employer for the member.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there any action I need to take?
[AGENT][NEUTRAL] Again, there's nothing for you to do right now at this point. Once we receive it, we'll automatically continue processing.
[CUSTOMER][POSITIVE] OK, thank you. Thank you so much. Thank you for assisting with me. Have a great day.
[AGENT][POSITIVE] You're welcome. Was there anything else I could assist you with today?
[CUSTOMER][POSITIVE] No, ma'am. Thank you.
[AGENT][POSITIVE] All right. Well, thanks for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you. Have a great day. Take care. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][POSITIVE] Thank you bye.