AccountId: 011433970860
ContactId: 751fc4a7-3d67-4cc5-a2b8-e93bee95b0a8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 493570 ms
Total Talk Time (AGENT): 154926 ms
Total Talk Time (CUSTOMER): 186681 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/751fc4a7-3d67-4cc5-a2b8-e93bee95b0a8_20250404T12:57_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from Memorial Healthcare, um, and I have a few claims that I need to verify the status of.
[AGENT][NEUTRAL] I can verify claim status. May I have a policy number?
[CUSTOMER][NEUTRAL] Yes, it's 02230098.
[AGENT][NEUTRAL] And may I have a good callback number for you?
[CUSTOMER][NEUTRAL] Yep, [PII].
[AGENT][POSITIVE] Thank you and I'm sorry, your first name again?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] [PII], thank you so much. May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. May I have the date of service?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, the date of service is [PII].
[AGENT][NEUTRAL] Total bill amount?
[CUSTOMER][NEUTRAL] Total build amount is so I just had that let me look at the claim again uh $468.50 and Medicare or I'm sorry, PHP made their payment and leaving a balance of $173.30.
[AGENT][NEUTRAL] Thank you for future reference, you may visit our website at [PII] to check claim status as well. One moment, I'll get this pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This one processed under claim number 3549496.
[AGENT][NEUTRAL] It looks like this one processed the benefit amount of 13,830 to the provider.
[CUSTOMER][NEUTRAL] OK, and when was that paid to us?
[AGENT][NEUTRAL] This one processed on.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and are you able to see if that check cleared?
[AGENT][NEUTRAL] I would have to send it over to finance to verify if this check is cleared.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] OK, all right, maybe we should check first in our records to see if we received it because it's not posted so.
[AGENT][NEUTRAL] I can give you the check number.
[CUSTOMER][NEUTRAL] Yeah, go ahead.
[AGENT][NEUTRAL] OK, it's 2021962.
[CUSTOMER][NEUTRAL] And the total amount was 13,830 on that check.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, I'll look into that one. I have a couple other patients that I need to look at. Do you have time for more?
[AGENT][NEUTRAL] Different
[AGENT][NEUTRAL] Different patient? OK. May I have a policy number?
[CUSTOMER][NEUTRAL] Yeah they're different patients, yeah.
[CUSTOMER][NEUTRAL] Yeah, just one second.
[CUSTOMER][NEUTRAL] It is 02230090.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] date of birth is [PII].
[CUSTOMER][NEUTRAL] And this patient I have quite uh like a few different dates of service for her.
[AGENT][NEUTRAL] May I have her first date of service?
[CUSTOMER][NEUTRAL] Yeah, the first data service is 7/25 of 24 with a total charge of $140 bail it's after insurance paid $32.60.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so this one processed under claim number 3495064. No benefits were payable.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEGATIVE] This one processed and denied on.
[AGENT][NEGATIVE] I do apologize, the system is extremely slow.
[CUSTOMER][NEUTRAL] That's OK. I know something about slow systems.
[AGENT][NEUTRAL] 821 of 24.
[CUSTOMER][NEUTRAL] OK, so no benefits payable is that billable to the patient?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then she had another data service of 99 of 24.
[AGENT][NEUTRAL] Total bill amount?
[CUSTOMER][NEUTRAL] Total bill amount was $141 balance after um insurance paid was $1891.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Looks like this one denied for the same reason under claim number 3529027. This one processed and denied on.
[AGENT][NEUTRAL] 1112, 2024.
[CUSTOMER][NEGATIVE] So no benefits again.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] I'm guessing I'm I'm guessing all the other dates the service are the same so.
[AGENT][NEUTRAL] I can pull them up if you like.
[CUSTOMER][NEUTRAL] Um, let's.
[CUSTOMER][NEUTRAL] Yeah, um, I'm actually gonna see if we can pull them in our into our system.
[CUSTOMER][NEUTRAL] Because we, we do have EOBs, but I think the whole.
[CUSTOMER][NEUTRAL] It these accounts where it works so I'm just following up on them so I'm gonna actually jump to a different patient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] They might they might be the same ID number though I didn't even look to see because they both have the same last name but.
[CUSTOMER][NEUTRAL] I'll go ahead and give you their ID when you're ready.
[AGENT][NEUTRAL] It
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] OK, 02230090 for [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And date of service?
[CUSTOMER][NEUTRAL] Is [PII].
[AGENT][NEUTRAL] In total bill?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Total bill was $591.25. Total after insurance paid was 21928.
[AGENT][POSITIVE] Thank you. Let me get this pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But it looks like this office visit shouldn't have dropped.
[AGENT][NEUTRAL] This one processed under claim number 3561902. Looks like this one paid a benefit amount of $18.57.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This one processed on.
[AGENT][NEUTRAL] Come on, sister.
[AGENT][NEUTRAL] 211 of 25.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Alrighty, that is it. That's all I had for today. Thank you so much.
[AGENT][POSITIVE] [PII], you're so welcome and thank you for calling American Public Life. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] You too bye.