AccountId: 011433970860
ContactId: 601a59f5-ba9c-42df-9a98-24e94145ec29
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 333390 ms
Total Talk Time (AGENT): 111440 ms
Total Talk Time (CUSTOMER): 101979 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/601a59f5-ba9c-42df-9a98-24e94145ec29_20250110T18:46_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I am calling to check on a couple of claims for a patient.
[AGENT][NEUTRAL] OK, Ms. [PII], I can help you with claims. Can you please give me your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Yep, it is [PII] and it is my direct line.
[AGENT][POSITIVE] OK, thank you so much. And then what is the patient's name?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Patient's name is.
[CUSTOMER][NEUTRAL] Well, we have it under [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then what is the patient's date of birth?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, thanks. And then what is the patient's policy number?
[CUSTOMER][NEUTRAL] Um, I'm showing, so on that insurance card, it shows inpatient and outpatient.
[AGENT][NEUTRAL] Either one of those numbers would be fine.
[CUSTOMER][NEUTRAL] OK, it is 02462268 M as in Mary, L as in Lima 8.
[AGENT][POSITIVE] OK, thank you. I appreciate you giving me the the policy number. And what is the date of service?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, the date of service is [PII], and it looks like I have a total of 3 bill amounts.
[AGENT][NEUTRAL] OK, can you give me the first one?
[CUSTOMER][NEUTRAL] Um, $1920.
[AGENT][NEUTRAL] OK and then what is the uh charge amount after primary paid their part?
[CUSTOMER][NEUTRAL] Well, so we're billing for anesthesia billing, and it shows Medicare A as their primary, however, they don't cover anesthesia. So then we have it as you guys and then their AMed insurance.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. All right. What is the name of the facility you're calling for?
[CUSTOMER][NEUTRAL] Holy Cross Hospital.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold, Ms. [PII]. I'm gonna pull this claim up for you and I'll be right back.
[CUSTOMER][POSITIVE] Perfect thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi Ms. [PII], this is [PII] back with you. So I did find the claim and let me give you the claim number it's 353-391-1.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] And the claim was denied because we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] OK, for primary, do you guys have it listed as AvMed?
[AGENT][NEUTRAL] Um, let me look and see what the group is under.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] And I
[AGENT][NEUTRAL] I'm gonna pull up and see what the group.
[AGENT][NEUTRAL] Um, their group that they work for carries now that doesn't necessarily mean that he has it with the group. Um, you had mentioned Medicaids, but I'm still gonna check and make sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] It's gonna be just a minute. I need to pull another screen up, so it's course thinking.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, the group is showing us Avied.
[CUSTOMER][NEUTRAL] OK perfect so I will go ahead and then just rebuild the claims then.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Um, to AMed, OK, perfect. Well, thank you so much. I really appreciate your help.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're very welcome, Miss [PII]. I hope you have a great weekend and we thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you. You as well bye bye.
[AGENT][NEUTRAL] Uh bye-bye.