AccountId: 011433970860
ContactId: 7eda7963-c23f-4b08-afdb-d6c99a7ca928
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 543929 ms
Total Talk Time (AGENT): 151823 ms
Total Talk Time (CUSTOMER): 198110 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/7eda7963-c23f-4b08-afdb-d6c99a7ca928_20250603T15:36_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APLva speaking. May I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII], and I'm calling from National Health on behalf of SSM Health De Paul Hospitals and Leos. Um, please know that the call is being recorded.
[AGENT][NEUTRAL] OK, and how may I assist you today?
[CUSTOMER][NEUTRAL] Yes, I'm calling to get the general claim status of validation.
[AGENT][NEUTRAL] OK, I can verify claim status for you. And your name is again?
[CUSTOMER][NEUTRAL] [PII]. My name is [PII] and what's your name as well?
[AGENT][NEUTRAL] It's [PII] and Ms. [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] The policy number is 01869189.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, my callback number is [PII].
[AGENT][NEUTRAL] OK, and the patient's name, date of birth?
[CUSTOMER][NEUTRAL] The patient's name is [PII]. Can I, can I, um, spell instead?
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] OK, I'm, yes, I'm here. Your phone keeps cutting out, but I don't show that patient under this policy number. What is that first and last name again?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] [PII], can I, can I spell the name? It's [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Please give me a moment. I want to be sure if it's [PII].
[CUSTOMER][NEUTRAL] Um, yes, [PII].
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] And just to confirm, you said the last name is spelled [PII]?
[CUSTOMER][NEUTRAL] Nope, it's, I'm sorry, that that wasn't what I said. I said [PII].
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and his date of birth?
[CUSTOMER][NEUTRAL] The date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] The date of service is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and the amount of the charge?
[CUSTOMER][NEUTRAL] The charged amount is 149.00.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And you're calling from again?
[CUSTOMER][NEUTRAL] I'm calling from SSM Health DePaul Hospital [PII].
[AGENT][NEUTRAL] OK, I'm showing that claim process is needing the primary insurance explanation of benefits.
[CUSTOMER][NEUTRAL] I didn't get what you said. I'm sorry.
[AGENT][NEUTRAL] The claim processed as needing the primary insurance explanation of benefits.
[CUSTOMER][NEUTRAL] Um, can you put it off slowly because I'm trying to put that in my notes, so you said a claim processed as the primary.
[AGENT][NEUTRAL] No, the claim processed as needing the primary insurance explanation of benefits.
[CUSTOMER][NEUTRAL] Oh, so the claim is needing, um, the primary EOB.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, but do you have the claim number and the date it was received?
[AGENT][NEUTRAL] Uh, claim received [PII], processed on [PII]. Claim number 3,533,870.
[CUSTOMER][NEUTRAL] Um, I'm sorry, can you please the most of them I'm sorry. You said it was received in November.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Process on [PII].
[CUSTOMER][NEUTRAL] Mhm. [PII] and process.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Alright, and the claim number, can you please repeat it for me again?
[AGENT][NEUTRAL] And the claim number.
[AGENT][NEUTRAL] 353-387-0.
[CUSTOMER][NEUTRAL] 353-387-0. OK. And
[CUSTOMER][NEUTRAL] So what's the claim information? So is this a denial or?
[AGENT][NEGATIVE] It was denied as needing the primary insurance explanation of benefits.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And um can you please provide me your time of filing for credit claims and appeals.
[AGENT][NEUTRAL] There is no timely filing for a corrected claim. For appeals, you have up to 180 days from the time the claim was processed to submit an appeal, and you must submit a letter stating the reason for the appeal.
[CUSTOMER][NEUTRAL] OK, and um for this case with the denial, so it means that um you require the explanation of benefits from the primary payer before you can proceed to um payment that's what it means.
[AGENT][NEUTRAL] Yes, since this policy is secondary.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK. And can you please provide me your mailing address and fax number?
[AGENT][NEUTRAL] Sure, mailing address [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] City, [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the fax number is
[CUSTOMER][NEUTRAL] And this is for both corrected claims and appeal.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And the fax number is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um OK um do you require an appeal form for any reason?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Do you require an appeal form for reconsideration?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um also I'd like to know what's the number of IPO levels that you allow.
[AGENT][NEUTRAL] Up to 2.
[CUSTOMER][NEUTRAL] So, OK.
[CUSTOMER][NEUTRAL] Alright, thank you very much and is it possible that you provide me a call reference number?
[AGENT][NEUTRAL] If you like, you may use my name at today's date.
[CUSTOMER][NEUTRAL] OK, and your name is [PII] and [PII]. Is that it?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, thank you very much.
[AGENT][POSITIVE] You're welcome thank you for calling APL have a great day.
[CUSTOMER][NEUTRAL] You too, bye.
[AGENT][NEUTRAL] Bye.