AccountId: 011433970860
ContactId: 54eabd57-72f1-45e8-b0b0-d796686f3a37
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 495959 ms
Total Talk Time (AGENT): 125861 ms
Total Talk Time (CUSTOMER): 141102 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/54eabd57-72f1-45e8-b0b0-d796686f3a37_20250602T19:34_UTC.wav
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[AGENT][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] This is [PII] how may I help you?
[CUSTOMER][NEUTRAL] Hi, this [PII] calling from Mercy Facility, checking on the claim status. Can you spell it out your name?
[AGENT][NEUTRAL] Yes, [PII] And can you spell your name for me also?
[CUSTOMER][NEUTRAL] Yes. My name is [PII].
[AGENT][NEUTRAL] OK, [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then I can look up claim status for you. Can I please get the member's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Name is [PII] Last name is [PII] Date of birth is [PII] is the date of birth. And the member ID is 02440291.
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me pull up that policy real quick.
[AGENT][NEUTRAL] All right, I've got [PII] pulled up. Can you please give me the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Data of services, it is 11.
[CUSTOMER][NEUTRAL] [PII], bill charges is $925 even.
[AGENT][NEUTRAL] OK, and then what are the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Uh, it's 925, madam.
[AGENT][NEUTRAL] That's after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Why, ma'am, you're, you're acting, uh, you're processing as a secondary?
[AGENT][NEUTRAL] Right, we are secondary. So what was the
[CUSTOMER][NEUTRAL] When did you receive this claim?
[AGENT][NEUTRAL] OK, first I need to get the questions answered. What is the amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] OK. So here I see that there is no primary insurance reflecting over here. The claim where the patient was active on the data service with the American public life. That is the reason I'm asking you, when did you receive the claim?
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, can you give me the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Mercy Hospital.
[AGENT][NEUTRAL] OK, thank you. I'm gonna put you on a quick hold while I look up this claim and I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 021.
[AGENT][NEUTRAL] Thank you for holding for me. I have the claim information for you, [PII]. The claim number is 3568021.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim has been denied.
[CUSTOMER][NEUTRAL] 8021. Yes, received one?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] The claim was received on.
[AGENT][NEUTRAL] [PII] and processed on [PII].
[AGENT][NEUTRAL] And the claim has been denied because the service was rendered after the termination date of the policy.
[AGENT][NEUTRAL] And the policy did terminate on [PII].
[CUSTOMER][NEGATIVE] Denied uh
[CUSTOMER][NEUTRAL] Because policy was termed, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] You mean member was not active on date of service?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] What is the effective date?
[AGENT][NEUTRAL] The effective date was [PII] and the policy terminated on [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] One second, [PII].
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] [PII] and the active date, the date of services, uh [PII]. Am I right?
[AGENT][NEUTRAL] Correct. That's the that's the date you gave me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So, can we bill this to patient, madam?
[AGENT][NEGATIVE] We don't give patient responsibility.
[CUSTOMER][NEUTRAL] OK. What is the call reference?
[AGENT][NEUTRAL] You can use my name, [PII] and today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, patient was not active on the date of service and um date is the [PII], correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me just check whether other claims have been paid for the date of service. Give me one second, ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. I have a few claims where we have received the payment, madam. Uh,
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Fine. Uh, let me.
[CUSTOMER][NEUTRAL] Do you see any other insurance, madam, which is active for the date of service?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. No issues, madam. Thank you. Have a great day.
[AGENT][POSITIVE] You have a wonderful day too. Is that everything before we
[CUSTOMER][NEUTRAL] Bye.