AccountId: 011433970860
ContactId: 8744d16a-8b2d-4a15-becf-619b5b403f14
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 349190 ms
Total Talk Time (AGENT): 98957 ms
Total Talk Time (CUSTOMER): 161994 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/8744d16a-8b2d-4a15-becf-619b5b403f14_20250306T15:00_UTC.wav
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[AGENT][POSITIVE] Thank you for calling and APL this is [PII] how may I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII] calling for Samaritan Hospital to check on a claim in status. Please be informed that this call is being recorded and monitored for quality and training purposes. How are you doing, [PII]?
[AGENT][POSITIVE] I'm doing good, [PII]. How are you doing today?
[CUSTOMER][POSITIVE] I'm doing good thank you so much for asking sorry.
[AGENT][POSITIVE] Awesome and you need help with the claim status is that correct?
[CUSTOMER][NEUTRAL] Like.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I can help you with the claim. um can I please get your callback number, sir, just in case our call is disconnected?
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Sure, my callback number it's gonna be [PII] and direct connect no extension.
[AGENT][NEUTRAL] OK, thank you sir and then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] OK. The patient's name is gonna be [PII], and last name could be spelled. It is [PII].
[CUSTOMER][NEUTRAL] And the member's member ID it is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and the patient's date?
[CUSTOMER][NEUTRAL] And the patient's date of birth?
[AGENT][POSITIVE] Yes, thank you.
[CUSTOMER][NEUTRAL] So, OK.
[CUSTOMER][NEUTRAL] OK. It's [PII].
[AGENT][NEUTRAL] Thank you, sir. And you said that you already had um a denial on the claim. Can you give me the claim number, please?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] OK, to receive the payment, yeah, it is 349.
[CUSTOMER][NEUTRAL] 377 8.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] that's.
[AGENT][NEUTRAL] OK, and can you give me, uh, the name of your facility and the charge amount for the claim, please?
[CUSTOMER][NEUTRAL] Yeah, sure. The facility name is gonna be Samaritan Hospital and you requested the NPA, right?
[AGENT][NEUTRAL] Sir,
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] The um charge amount for the claim?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] All right. OK. Charge amount's gonna be $247 even.
[AGENT][NEUTRAL] OK, and what was your question you just asked me, sir?
[CUSTOMER][NEUTRAL] I just wanna check on the claim to status. The claim denis, uh, non-covered charges under the patient's plan or the provider's plan. I wanna check for that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me look and see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The, um, charges were denied for non-covered for the patient's policy.
[CUSTOMER][NEUTRAL] OK, and could you please, uh, elaborate a little more about that now. It is for the patient's policy coverage or the birth, OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, for the patient's policy, charges incurred at an independent lab are not covered under the benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, OK, got that.
[CUSTOMER][NEUTRAL] So in this case, can we build the patience for the responsibility?
[CUSTOMER][NEUTRAL] Balance.
[AGENT][NEUTRAL] I can't give patient responsibility, sir. That's determined by the provider.
[CUSTOMER][NEUTRAL] Uh, I know, I'm just.
[CUSTOMER][NEUTRAL] OK, and uh I'm just asking whether if there's any other coverage for the patient.
[CUSTOMER][NEUTRAL] Just sufficient to have any other coverage.
[AGENT][NEUTRAL] I do not have any other coverage.
[CUSTOMER][NEUTRAL] All right, OK.
[CUSTOMER][NEUTRAL] OK, in case there is no other coverage for the patient, we can bill the patient, right?
[AGENT][NEUTRAL] I can't tell you if you can build a patient or not, but we don't have any other coverage.
[CUSTOMER][NEUTRAL] All right, OK.
[CUSTOMER][POSITIVE] Yeah, [PII], thank you so much for the information.
[CUSTOMER][NEUTRAL] OK I don't have any more questions, sir. Can I have the call reference number for this call?
[AGENT][NEUTRAL] Yes sir, you can use my name [PII] and today's date.
[CUSTOMER][NEUTRAL] Alright, OK, [PII], could you please spell your name for me?
[AGENT][NEUTRAL] Yes, sir. It's [PII]
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] There you go, OK.
[CUSTOMER][NEUTRAL] And your last initial please?
[AGENT][NEUTRAL] My last initial for my last name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] All right, OK. I'm so sorry time.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] OK [PII], thank you so much for assisting me. Do you have any more questions here. Take care.
[AGENT][POSITIVE] You're very welcome. You have a good day, [PII]. Thank you for calling APL.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Yeah, bye-bye. You too. Take care.
[AGENT][NEUTRAL] Bye-bye, sir.