AccountId: 011433970860
ContactId: 53d94e74-f800-4527-9243-3877c3bc8c5f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1573459 ms
Total Talk Time (AGENT): 458893 ms
Total Talk Time (CUSTOMER): 340879 ms
Interruptions: 2
Overall Sentiment: AGENT=1.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/53d94e74-f800-4527-9243-3877c3bc8c5f_20250213T13:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from Mercy Hospital.
[CUSTOMER][NEUTRAL] Mercy Hospital.
[AGENT][NEUTRAL] Did you say your name is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, and how can I help you today, [PII]?
[CUSTOMER][NEUTRAL] Claim status.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII] with extension [PII].
[AGENT][NEUTRAL] Thank you. And what is the pay? Do you only have one claim, [PII], to check status on?
[CUSTOMER][NEUTRAL] Uh, I have 3 claims.
[AGENT][NEUTRAL] OK, are they 3 claims for the same patient or 3 different patients?
[CUSTOMER][NEUTRAL] Three different patients.
[AGENT][NEUTRAL] So you have one data service for 3 different patients, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, yes, [PII], I can help you with those. So.
[AGENT][NEUTRAL] To let you know up front you're gonna use my name that I gave you along with today's date as your call reference number for each one.
[AGENT][NEUTRAL] Also, any information that I provide for you today will be a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And lastly, [PII], if we do have the claims on file and you need a copy of our explanation of benefits, once you have the claim number you can go to our portal to print those and our portal website is secured.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is your first patient's policy number please, [PII]?
[CUSTOMER][NEUTRAL] Yeah. 1st 1, 1191364.
[AGENT][NEUTRAL] OK, did you say 1191364? Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] And what is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name, it is [PII]. Date of birth, [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Date of service, yeah. Date of service [PII]. Total bill amount $7,455.24.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so this claim was received, [PII], one moment please and I'll provide that information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim was received on 9-19-2024. It was processed and denied on 9-24-2024.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 3508765. So let me say that again, 3508765.
[AGENT][NEUTRAL] And this claim was denied. The reason for the denial states these services were rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] OK. Now you're stating that member not active for the date of service?
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] That is correct, and he did not have a, this policy was not active for data service and there was no other policy that was active for data service.
[CUSTOMER][NEUTRAL] OK. And also can you please provide me the effective date and the term date for this number?
[AGENT][NEUTRAL] Effective date [PII].
[AGENT][NEUTRAL] Termination date [PII].
[CUSTOMER][NEUTRAL] OK, stating that [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Good, thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And is there anything else I can help you with on this claim?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] For this claim I'm done.
[AGENT][NEUTRAL] OK, one moment, please.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what is your next patient's policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Next policy number.
[CUSTOMER][NEUTRAL] 02352914.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And also, uh, did you close the previous one?
[AGENT][NEUTRAL] I did, yes, ma'am.
[CUSTOMER][NEUTRAL] Mm OK.
[AGENT][NEUTRAL] What was your, uh, you had an additional question?
[CUSTOMER][NEUTRAL] Uh, yes, because the previous one, we did not receive the explanation of benefits I need the EOB.
[AGENT][NEUTRAL] That is correct and that is why, correct, so you would print that from our portal at the website that I gave you initially secured. [PII].
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Yes ma'am, the first word is secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. And you're not able to fax or mail.O?
[AGENT][NEUTRAL] It's easier if you print it directly by using the claim number that I gave you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And this itself or we need to register.
[AGENT][NEUTRAL] It's a, yes, ma'am. It's a self-registering where you would set up your own username and password.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. It will be uh open the same day, or we need to wait for any request or we need to raise any request?
[AGENT][POSITIVE] No, ma'am, it's instant. No ma'am, it's instant. Once you enroll, you should use that claim number and be able to print to pull up the EOB and print that.
[CUSTOMER][NEUTRAL] OK, understand.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you. Because the next two will be the same like we have called and requested the explanation of benefits.
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] Right. So since you've not received it, then yes, ma'am, you would just need to print it. It will only make so many attempts to fax.
[CUSTOMER][NEUTRAL] Let me check whether I have.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if the fax line, if it will not go through, then yes, ma'am. You would just need to print that. It would be the easiest.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, but here I see that there's so many APL American.
[CUSTOMER][NEUTRAL] OK. And also I need to register for the
[CUSTOMER][NEUTRAL] Uh, tax ID I need to enter the total or I need to only enter the one?
[AGENT][NEUTRAL] For each one that you were, yes, ma'am, is there different?
[CUSTOMER][NEUTRAL] Tax ID number.
[CUSTOMER][NEUTRAL] Yeah, I have 3 different uh claims I just mentioned previously, so I need to download the.
[AGENT][NEUTRAL] Under the tax ID number.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So I need to download the 3, I need to use registered with the 3 or only 1 is enough?
[AGENT][POSITIVE] Uh-huh, correct.
[AGENT][NEUTRAL] If it's under the same tax ID number, it should be just under the one. If it's different tax ID numbers then you would have to do that because the claim is under different if it, you know, the tax ID number is associated to the claim.
[CUSTOMER][NEUTRAL] Oh yeah. And also the username will be different for the, uh, different, different tax ID number?
[AGENT][NEUTRAL] If you set that up differently, you're the one that's gonna create that. Mhm.
[CUSTOMER][NEUTRAL] Uh, the same user name.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You you can create whatever user name you want.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Because I'm seeing only when I'm only one patient tax ID number and the account number.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] Right, so you will do each one at a time just like we have to check claim status?
[AGENT][NEUTRAL] One at a time, you will have to print them one at a time.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh can you please help me with how I need to register with the all tax ID numbers?
[AGENT][NEUTRAL] You would have to do each different tax ID number is a different registration.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because the claims are tied to the.
[AGENT][NEUTRAL] Provider tax ID number?
[AGENT][NEUTRAL] For their data service.
[CUSTOMER][MIXED] OK, but while I'm entering it was showing an error.
[CUSTOMER][NEUTRAL] So can you please uh fax it to you to us?
[AGENT][NEUTRAL] OK, I will fax them, but you do need to set up your portal for future reference if you have requested that they be mailed and faxed and they have not been received, the portal is the only other option.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Sure. I will try after some time because, yeah, now it's showing a pop up like a error. Now, I will try after some time, but can you please fax that you be to us now at this time.
[AGENT][POSITIVE] And it is the most efficient offer.
[AGENT][NEUTRAL] Yes, and they will have to be faxed one at a time just like printing them from the portal you have to do them one at a time. So what is the fax number that you want the first claim we checked sent to, please?
[CUSTOMER][NEUTRAL] For this claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Fax number 678.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and does it need to be put to your attention, [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, I will provide the next 21.
[AGENT][NEUTRAL] OK, I'm, yes, but I have to do them one at a time, so we will have to verify each information again it is just like the portal they have to be one at a time. I can't fax them all together.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And again, the fax number is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] 4730. Yes, ma'am, that's what I said.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] Yeah, it's correct.
[AGENT][NEUTRAL] OK. So the first one has been sent.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Just one moment for me to get back into that policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the next member's name and date of birth please, [PII].
[CUSTOMER][NEUTRAL] Yeah. Next member's name, it is [PII]. Date of birth, [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Data service and total bill amount.
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] Date of service, [PII]. Total bill amount $755 even.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Claim number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Dimension.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Claim number 346.
[CUSTOMER][NEUTRAL] 7020.
[AGENT][POSITIVE] Thank you, data service and total bill amount.
[CUSTOMER][NEUTRAL] Date of service, [PII]. Total bill charges $755 even.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you, one moment, OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So you already have the status on the claim, you're just needing the explanation of benefits. Is that correct?
[CUSTOMER][NEUTRAL] Yeah, yeah. Actually, we have called and we get that information like the claim process date, received it and which was applied towards the deductible 159.62.
[CUSTOMER][NEGATIVE] We have requested that um you be but still not received.
[AGENT][NEUTRAL] OK, and again, [PII], let me look, let me look at something first.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, it says my fax was successfully sent.
[CUSTOMER][NEUTRAL] OK, thank you. And it's I just provided the same information like uh it was applied towards the deductible, right? Balance.
[AGENT][NEUTRAL] OK, so on the other.
[AGENT][NEUTRAL] Oh, I'm not checking the status. I was only faxing the EOB since you said you already have status. So give me just a moment.
[CUSTOMER][NEUTRAL] Under this claim number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh no, I'm just verifying that it's OK.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] And that is correct.
[AGENT][NEUTRAL] On the benefits being applied to the policy deductibles.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the amount, yes, 159.62. And give me just a moment, this explanation of benefits is still loading.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] I'm having some, just one moment, please, [PII].
[CUSTOMER][POSITIVE] OK. Yeah, take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and your that that explanation of benefits have also been faxed. And what is your next? You're welcome. What is your patient's, your last patient's policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah. 025.
[CUSTOMER][NEUTRAL] 124 72.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. And your patient's name, please, and date of birth?
[CUSTOMER][NEUTRAL] Yes, patient's name, it is [PII]. Date of birth [PII].
[AGENT][POSITIVE] Thank you. Day of service and total bill amount?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Date of service [PII]. Total bill amount $3,589 even.
[AGENT][POSITIVE] Thank you. And the claim number, please.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And the claim number 3508192.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And also for this claim, they stated that the claim denied for member has met maximum benefits and it was applied towards the patient responsibility balance.
[AGENT][NEUTRAL] And we did not determine patient responsibility, that would be up to the provider, but I can provide you the remark on the denial.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The denial remark on this claim states maximum benefit for this state of service has been met.
[CUSTOMER][NEGATIVE] And also did they mention uh how much we need to bill the member and they did not mention anything.
[AGENT][NEUTRAL] We didn't
[AGENT][NEUTRAL] That is correct because as I just stated, we do not determine patient responsibility. That would be up to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And it's still loading for the explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so that has also been faxed to the same number. I have not yet received a confirmation of the second explanation of benefits being confirmed yet, but I did on the first one. So we will make approximately 5 attempts to try and fax them to you before it times out. So again, if you don't receive them this time, then you would just need to set up your profile in the portal to print them from there.
[CUSTOMER][NEUTRAL] OK, sure. OK, now we are faxed to the EOB, right?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I have, yes, ma'am. Mhm.
[CUSTOMER][POSITIVE] OK. OK, thank you, thank you for providing this information. Have a great day. Bye. Take care.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] Yes, ma'am. Well, I hope you do too, and is that all I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] Yeah, nothing, thank you.
[AGENT][POSITIVE] OK, well, thank you again for calling APL and I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.