AccountId: 011433970860
ContactId: 7cdf9f82-f44a-4fc6-8285-7692859827b6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 744239 ms
Total Talk Time (AGENT): 149495 ms
Total Talk Time (CUSTOMER): 194398 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/7cdf9f82-f44a-4fc6-8285-7692859827b6_20250320T13:25_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi there, my name is [PII]. I'm calling with Saint Mary's Regional to follow up on a claim status.
[AGENT][POSITIVE] Well, [PII], it would be my pleasure to assist you with the claim status. What is the callback number?
[CUSTOMER][NEUTRAL] That is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] 02555592
[AGENT][NEUTRAL] Thank you, [PII], and the patient's name and date of birth, please, ma'am.
[CUSTOMER][NEUTRAL] I have Alannaise [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And I
[AGENT][NEUTRAL] Let's see, I'm getting that pulled up. What is that data surface?
[CUSTOMER][NEUTRAL] That is for [PII].
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Bear with me just one second.
[AGENT][NEUTRAL] What's the bill amount please ma'am?
[CUSTOMER][NEUTRAL] That is for $28,289.98.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the name of the facility?
[CUSTOMER][NEUTRAL] Yes, it's called Saint Mary's Regional.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, [PII], I did locate that claim. The claim we received, uh, we received that claim on [PII].
[AGENT][NEUTRAL] And processed on [PII].
[AGENT][NEGATIVE] And bear with me just one second, I'm getting a denial.
[CUSTOMER][NEUTRAL] OK, so we, um, we know it's a denial. Um, I know when I followed up back on [PII], I spoke to [PII], which she had stated she sent a message to [PII], um, to get the, the detail, the detailed status on exactly what is being requested on that denial.
[AGENT][NEUTRAL] And you have
[CUSTOMER][NEUTRAL] And that was on [PII].
[AGENT][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] I'm checking, bear with me just one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you have not received a call back from [PII]?
[CUSTOMER][NEUTRAL] Not that I'm aware of.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I haven't seen any messages or anything.
[AGENT][NEUTRAL] Hang on just a second.
[AGENT][POSITIVE] I'm checking on it for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, is your callback number still the [PII]?
[CUSTOMER][POSITIVE] That is correct, yes, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So what I can do is I can send Ms. [PII] another email and ask her to please contact you.
[CUSTOMER][POSITIVE] OK, yes, that'd be great thank you. So she doesn't, um, I guess let you guys know what status or how does that normally work?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I guess if she, you know, states that.
[AGENT][POSITIVE] Yeah, I got you.
[CUSTOMER][NEGATIVE] She can't reach me or, you know, she doesn't, I guess inform y'all of the status or what is normally the process of that.
[AGENT][NEUTRAL] I'm checking on that. Do you mind if I put you on a brief hold, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That's, yes, that's fine, thank you.
[AGENT][POSITIVE] All right. Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, thank you. I appreciate your patience um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] I was checking to see if [PII] was in.
[AGENT][NEUTRAL] She is out today. Unfortunately, I'm sorry, but I'm going to send an email to get this taken care of.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] And hopefully you'll get that.
[AGENT][NEUTRAL] Um, call and get that resolved. Now they did say that a letter.
[AGENT][NEUTRAL] Was, did you re you received the EOB for the claim?
[CUSTOMER][NEUTRAL] So we have an EOB, but it's not, it doesn't specify exactly what is going on with this claim. Um, uh, I know [PII] wasn't able to really thoroughly explain the denial as to what, what is exactly what is being requested from the provider at this time. um, so that's where, where we at.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It, it looks like you.
[AGENT][NEUTRAL] Yeah, it looks like the tax ID number, uh, there's a discrepancy with the tax ID number, and it states that a letter was mailed to the provider with insurance instructions on resolving the discrepancy. Have you all received that yet?
[CUSTOMER][NEUTRAL] Yes, so what we did from what we understand what was being requested, we faxed the letter back, a claim form, and the W-9 form to verify the facility with the address. It has, it has our NPI, our tax ID and all that information on there, um, we faxed that information back on.
[AGENT][NEUTRAL] So you did send it back?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Yes, we faxed it on back on [PII] is what we that information we faxed which [PII] did confirm that information to be received and processed and she stated it processed actually the next day doesn't sound like it was actually reviewed um then she stated that she feels like it's still denying for the same reason.
[CUSTOMER][NEUTRAL] And that's why we're here trying to reach [PII] to provide us with further details as to what exactly is being requested if that information was.
[CUSTOMER][NEGATIVE] Not the correct information that we submitted.
[AGENT][NEGATIVE] Gotcha.
[AGENT][NEUTRAL] Gotcha. OK.
[AGENT][POSITIVE] Well, I'm fixing. I'm gonna send this to my supervisor and so they can see everything and see if we can get this resolved for you, OK?
[CUSTOMER][POSITIVE] Yes, thank you so much.
[AGENT][POSITIVE] Uh, it's been such a pleasure, and I'm sorry that, um, we apologize for any inconvenience.
[CUSTOMER][POSITIVE] Oh, you're OK. I, I appreciate your help today and trying to resolve this matter. We'll just, uh, I'll just allow time to hear a response from [PII] or your supervisor, um, but that's, this is literally the only number I called in regards to today.
[AGENT][POSITIVE] OK. Well, it's been a pleasure, [PII], and thank you for your patience. I appreciate it and I hope you have a wonderful day.
[CUSTOMER][POSITIVE] You as well thank you so much. Take care.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Hm