AccountId: 011433970860
ContactId: 60b0ed66-5062-4fdd-a03e-fb4786f489a6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 482709 ms
Total Talk Time (AGENT): 102369 ms
Total Talk Time (CUSTOMER): 232025 ms
Interruptions: 3
Overall Sentiment: AGENT=0, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/60b0ed66-5062-4fdd-a03e-fb4786f489a6_20250417T16:14_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. Good morning. This is [PII] from Ardent Health Services, and I would like to check on some claims status for a patient.
[AGENT][NEUTRAL] OK, I can help you with claim status. And I'm sorry, what was your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Hey, I, do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Did you
[CUSTOMER][NEUTRAL] Yes. It is 02462880.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, thank you. And do you have the patient name and date of birth?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] March Yes.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I think you
[AGENT][NEUTRAL] And what was that data service we're looking at?
[CUSTOMER][NEUTRAL] OK, the for the service is [PII] build amount 224.
[AGENT][NEUTRAL] OK, looks like we received that on 9-16-24, and that was processed 9-19-24.
[CUSTOMER][NEUTRAL] I want to know the status.
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] Um, office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] Oh, OK, so, uh, these are not covered under this members plans in this case, well, it would be like a patient responsibility, right?
[AGENT][NEUTRAL] Um, so we don't determine patient responsibility. We just process the claims according to their policy. This is a supplemental secondary policy.
[CUSTOMER][NEUTRAL] Yeah,
[CUSTOMER][NEUTRAL] Oh, OK, I understand that. Thank you so much, [PII]. So well, in that case, are you able to send me, uh, via email or fax the EOB?
[AGENT][NEUTRAL] Yes, what's your facts?
[CUSTOMER][NEUTRAL] OK, perfect. So via fax in this case, the fax number is [PII]. You can put attention to my name, please.
[AGENT][NEUTRAL] OK, and will you spell that for me one more time? So sorry.
[CUSTOMER][NEUTRAL] Sure, no worries. [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] Thank you. And could you please help me with the next date of service?
[AGENT][NEUTRAL] Is it for the same patient?
[CUSTOMER][NEUTRAL] Yes, it is for the same patient. all of the claims are for the same patients.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] And if you can add HOB to the fax it would be great. I appreciate it.
[AGENT][NEUTRAL] OK, um, what was the date of service?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] It is [PII], middle amount 224.
[CUSTOMER][NEUTRAL] 8225.
[AGENT][NEGATIVE] And that's gonna be denied for the same reason.
[CUSTOMER][NEUTRAL] OK, could you please tell me the received date and process date?
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] And received 1025 24, process 1028, 24.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, and process.
[CUSTOMER][POSITIVE] 28 perfect and the next date of service.
[CUSTOMER][NEUTRAL] Is [PII]. Mild amount, 224.
[CUSTOMER][NEUTRAL] Yeah, I had those more claims for the same case.
[CUSTOMER][NEUTRAL] For you
[CUSTOMER][NEUTRAL] The date of service or the next one is from [PII] and [PII].
[AGENT][NEGATIVE] Uh, that was received 1025 24, processed 1028, 24, and denied for same reason.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Next date of service is [PII] M amount $45.
[CUSTOMER][NEUTRAL] So in this case do we send you the the claim?
[CUSTOMER][NEUTRAL] OK, no fine for [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And so we
[AGENT][NEUTRAL] Uh, that was received on [PII]. Process 24-2025.
[CUSTOMER][NEUTRAL] Ok, and I can send it to the part that you.
[AGENT][NEUTRAL] Uh, we need a copy of the explanation of benefits.
[CUSTOMER][NEUTRAL] Oh, OK, so the primary is COB, right?
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And so what would be the best way we can send, send it over to you via fax as well?
[AGENT][NEUTRAL] Yes, fax is [PII].
[CUSTOMER][NEUTRAL] The one
[CUSTOMER][NEUTRAL] [PII] just to make sure [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, do I need to, to put attention to anyone?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] No, that goes straight to our claims.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, the next date of service, it is [PII].
[CUSTOMER][NEUTRAL] Mild amount 479.
[CUSTOMER][NEUTRAL] so.
[CUSTOMER][NEUTRAL] They're
[CUSTOMER][NEUTRAL] OK, can we take another one?
[AGENT][NEUTRAL] Uh, received 2 1825, process 2 1925.
[AGENT][NEUTRAL] And we need the copy of the explanation of benefits.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] And the last one is [PII], build the amount 224.
[AGENT][NEGATIVE] I received 3 10 [PII], process 3 11 2025, and that was non-covered service.
[CUSTOMER][NEUTRAL] OK, non-covered service, perfect. OK, so, well, that's all I needed to know sir for [PII], and regarding the facts that I will be sending over to you, um, do I need to follow up in a week, more or less?
[AGENT][NEUTRAL] Uh, yes, 7 to 10 more.
[CUSTOMER][NEUTRAL] What's the turn around time you can see it?
[AGENT][NEUTRAL] 7 to 10 working days.
[CUSTOMER][NEUTRAL] 7 to 10 working days. Oh, OK, perfect. Uh, well, finally, do you have a reference number for this call?
[AGENT][NEUTRAL] Um, it's just my name and today's date.
[CUSTOMER][POSITIVE] OK, perfect, [PII]. Well, that's what I needed to know so far. I appreciate your help and I hope you have a wonderful day.
[AGENT][POSITIVE] OK, thanks for calling APL. You as well.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you bye bye.