AccountId: 011433970860
ContactId: 67ae3332-2812-45a5-a5f7-45db1705484c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 637690 ms
Total Talk Time (AGENT): 147951 ms
Total Talk Time (CUSTOMER): 292379 ms
Interruptions: 5
Overall Sentiment: AGENT=1.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/67ae3332-2812-45a5-a5f7-45db1705484c_20250516T18:57_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh hi, [PII]. My name is [PII] calling you from Mercy Hospital. I'm calling you to information on a claim.
[AGENT][NEUTRAL] OK. Happy to check on the claim. What is the policy number?
[CUSTOMER][NEUTRAL] Yes. So that policy number under 02069892.
[CUSTOMER][NEUTRAL] It's 52 weeks.
[CUSTOMER][NEUTRAL] You.
[AGENT][NEUTRAL] Thank you. And can I get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah. Their name uh [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you. And then what's the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the build amount.
[CUSTOMER][NEUTRAL] $609 even.
[AGENT][NEUTRAL] OK. Thank you. One moment.
[CUSTOMER][NEUTRAL] Maybe
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Do we have a different bill amount after the primary paid?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes, $139.40.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so it looks like
[AGENT][NEUTRAL] We did receive a claim for the state of service. Uh, the claim was paid. It looks like $250 went towards the patient's deductible on this plan.
[CUSTOMER][NEUTRAL] Patient's deductible, how you said $250 right?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct, was applied towards the patient deductible.
[CUSTOMER][NEUTRAL] Mm, so we actually have called you on um [PII], and one of your representatives, [PII] said.
[CUSTOMER][NEUTRAL] Um, the claim was allowed $139.40 and that was applied towards member responsibility. And she didn't say that $250.
[AGENT][NEUTRAL] Mm, it looks like the billed amount was 139.40. It was applied towards the deductible. Would you like a copy of the EOB?
[CUSTOMER][NEUTRAL] Yeah, I requested on [PII] or [PII] but haven't received it yet.
[AGENT][NEUTRAL] What's a good fax number?
[CUSTOMER][NEUTRAL] Our fax number is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Should I mark attention to anybody on this?
[CUSTOMER][NEUTRAL] Um, you can use my name. You can mark me. Yeah, or else do you have an option to send it via email?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] No, we can only send it via fax.
[CUSTOMER][POSITIVE] Oh, no problem.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, that's on its way to you so it should be there in the next few moments. Would you like the claim number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] I'm sorry, your voice is breaking.
[AGENT][NEUTRAL] The fax is on its way to you. You should have it in the next 5 minutes. Would you like the claim number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, yes, I have it in here. Claim number 3498022 received on [PII] and processed on [PII]. Is that right?
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else?
[CUSTOMER][NEUTRAL] No problem. And call reference yeah call reference number is your name in today's date?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Yeah, and you said your name was?
[AGENT][NEUTRAL] My name is [PII], that's [PII]
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][POSITIVE] Thank you, sir. I have one more claim here. Can you please help? Uh, yeah.
[AGENT][NEUTRAL] Different patient
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] Yes, please. I have like 2 more claims in here. Hang on, I'll just give you that next member ID number.
[CUSTOMER][NEUTRAL] I'm just.
[CUSTOMER][NEUTRAL] Pulling up
[CUSTOMER][NEUTRAL] That ID number.
[CUSTOMER][NEUTRAL] Uh, yeah, there we go. 01828767.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] [PII] and the middle amount was um $560. After primary pay, the leftover balance was $50 even.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so we did receive the claim for the state of service. Uh, the $50 amount was applied towards the calendar year deductible of $1000.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, calendar deductible of 1000. So, per year, per 10 year, they have
[CUSTOMER][NEUTRAL] Um, an amount of $1000 right, as deductible. So they met it.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. So, yeah, on the same day, like [PII] or [PII], we actually have uh you know, requested and you will be through fax, but we haven't received it yet.
[CUSTOMER][NEUTRAL] Not just the patient.
[AGENT][NEUTRAL] OK, I'll resend this one.
[CUSTOMER][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] You'd have an option to send it via email.
[CUSTOMER][NEUTRAL] Because facts is sometimes you know we we are getting it.
[AGENT][NEGATIVE] We don't send them via email just because the email is not secure enough.
[AGENT][NEUTRAL] I'm showing that the first one was successfully sent, so you should have it by this point.
[CUSTOMER][NEGATIVE] But not really. We haven't received it.
[AGENT][NEUTRAL] And the fax number is [PII], is that correct?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, that one's on its way.
[CUSTOMER][POSITIVE] OK. Thank you so much and
[CUSTOMER][NEUTRAL] Yeah. OK. I'll give you the next claim information with that member ID number. One moment, please.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] What's the next policy number?
[CUSTOMER][NEUTRAL] 5
[CUSTOMER][NEUTRAL] Yes please one moment.
[CUSTOMER][NEUTRAL] So the next policy number, 01828760 and that is for [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Alright, and data service for this?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh 615-2024 with amount billed.
[CUSTOMER][NEUTRAL] $238 even. After primary pay, the balance was $50 even.
[CUSTOMER][NEUTRAL] And then I.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so claim is received on this one also, the $50 was applied towards the deductible which is $1000 and I'll fax you this EOB also.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, what's it for the claim number ending with 5353?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I received on [PII] and posted on [PII].
[AGENT][POSITIVE] Uh, correct, yes.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] That one's on its way to you as well. Did you have anything else you need me to check for you today?
[CUSTOMER][POSITIVE] Uh, not, mm, that's all for today. Thank you so very much. Have a happy weekend. Bye-bye.
[AGENT][POSITIVE] You're welcome. Have a good day.
[AGENT][NEUTRAL] Mhm bye bye.
[CUSTOMER][NEUTRAL] Bye bye.