AccountId: 011433970860
ContactId: 5d8b8b76-fef4-4be9-b614-b3c36f4aefe6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 463540 ms
Total Talk Time (AGENT): 210487 ms
Total Talk Time (CUSTOMER): 134605 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/5d8b8b76-fef4-4be9-b614-b3c36f4aefe6_20250203T14:07_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good morning. My name is [PII]. I'm calling to check on the claim status.
[AGENT][POSITIVE] [PII], it would be my pleasure to assist you. What is a good callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, [PII]. And the policy number for the patient, please.
[CUSTOMER][NEUTRAL] 442-767-574
[AGENT][NEUTRAL] OK, so that's the social?
[CUSTOMER][NEUTRAL] Uh, that's the number we, uh.
[AGENT][NEUTRAL] Sounds like it's so.
[CUSTOMER][POSITIVE] I just love the people that register, register information.
[AGENT][NEUTRAL] What's the last name of the patient?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, that must be their social.
[AGENT][NEUTRAL] Let me get this pulled up.
[CUSTOMER][NEUTRAL] Let me look at the.
[CUSTOMER][NEUTRAL] And of course I don't have a card copy, yep, that's, that's gotta be a social.
[AGENT][POSITIVE] I'm gonna take care of you, [PII], and give me just one second, let me get.
[AGENT][NEUTRAL] What I think is their policy number?
[AGENT][NEUTRAL] What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Her date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I found it. OK, I can give you [PII]'s policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, I'm ready.
[AGENT][NEUTRAL] Alright, so, um, her policy number is 188.
[AGENT][NEUTRAL] 858 88.
[AGENT][NEUTRAL] And I'll repeat it's 188.
[CUSTOMER][NEUTRAL] 188.
[AGENT][NEUTRAL] 858-88 yes ma'am.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] So that's the seven digit ID number.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEGATIVE] OK, just wanna make sure cause those 8s are throwing me off.
[AGENT][NEUTRAL] I know it's like it's 1 and then 3 8s and then 5 and 2 8s.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Repetitive numbers do that to me too. Um, what is that data service, [PII]? I can help you with that claim status.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is the bill amount?
[CUSTOMER][NEUTRAL] $430.
[AGENT][NEUTRAL] And the facility name please, ma'am?
[CUSTOMER][NEUTRAL] SSM Health Medical Group.
[AGENT][NEUTRAL] Is that Swanny Medical?
[AGENT][NEUTRAL] Center.
[CUSTOMER][NEUTRAL] Yeah, uh, let's see.
[AGENT][NEUTRAL] Clinic.
[CUSTOMER][NEUTRAL] Yes, it's show, Oklahoma.
[AGENT][NEUTRAL] Shawny, not. Yeah, Shawny, sorry, I've misread it.
[AGENT][NEUTRAL] OK, so we do have a claim for Shawnee Medical Center Clinic.
[AGENT][NEUTRAL] And that claim we received, let me get that receipt date for you.
[AGENT][NEUTRAL] It was received on [PII]. No, yeah, and processed on [PII].
[AGENT][NEUTRAL] The 99214 was denied as office visits are not covered under the patient's plan.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the 11,200 was denied as services are not covered when performed in a doctor's office.
[CUSTOMER][NEUTRAL] And what's the claim number?
[AGENT][NEUTRAL] Claim number is 342.
[AGENT][NEUTRAL] 1 I'm sorry, 3,421,470.
[CUSTOMER][NEUTRAL] And is it possible I can get a copy of the EOB?
[AGENT][NEUTRAL] I can fax you a copy of the EOB is quicker in our provider portal at [PII].
[AGENT][POSITIVE] It's a quick self registration and I can assist you with that if you would prefer that.
[CUSTOMER][POSITIVE] Oh, please do. Yes, please do.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright, if you'll go to um [PII].
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sign in as.
[CUSTOMER][NEUTRAL] I actually have.
[AGENT][NEUTRAL] Oh, do you have an account?
[CUSTOMER][NEUTRAL] Access to it, uh, yes, but the thing is I can't.
[CUSTOMER][NEUTRAL] Locate what I'm looking for because it's telling me I need a claim number.
[AGENT][NEUTRAL] OK, I can give you the claim number.
[CUSTOMER][NEUTRAL] OK, let me, uh, get my password here really quick.
[CUSTOMER][NEUTRAL] OK, I'm in now.
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] So the claim number you gave me the 3,421,470 use that?
[AGENT][NEUTRAL] Yes, ma'am. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, telling me no claim file.
[CUSTOMER][NEUTRAL] I put in the claim number I put in there.
[AGENT][NEUTRAL] And it's under that tax ID number?
[CUSTOMER][NEUTRAL] Now that might be what the issue is, let me see.
[CUSTOMER][NEUTRAL] I think when I registered I might have used a different tax ID number.
[CUSTOMER][NEUTRAL] I might need to add this one.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] And I don't mind waiting or I can fax this to you either way.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] You might have to fax it to me.
[AGENT][NEUTRAL] I can do that. Give me.
[CUSTOMER][NEUTRAL] Because I don't know how to go in here and add another tax ID number on here.
[AGENT][NEUTRAL] You just go out and go in as a new user.
[AGENT][NEUTRAL] To start over.
[CUSTOMER][NEUTRAL] OK, I'll do that just fax it to me and I'll just do that.
[AGENT][NEUTRAL] All right. And you spell your name, is it [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, give me just one second to prepare this fax for you and I'll get that fax number and get it on the way for you. Bear with me just one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm ready for the fax number, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And just to verify that fax number, I am sending this to [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] All right, [PII], that is on the way for you. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, I just need a reference number for the call.
[AGENT][NEUTRAL] Reference number is my name and today's date, and I spell my name [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All righty. Well, thank you so much, [PII].
[AGENT][POSITIVE] And thank you for calling [PII]. I hope you have a lovely day. It was a pleasure to assist you with that claim status. Take care.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][NEUTRAL] Bye-bye. Mhm.