AccountId: 011433970860
ContactId: 8846f1f5-3511-4ce5-b517-a275aabb42bb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 499720 ms
Total Talk Time (AGENT): 185196 ms
Total Talk Time (CUSTOMER): 166468 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/8846f1f5-3511-4ce5-b517-a275aabb42bb_20250310T12:40_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. My name is [PII]. Last name is [PII] calling from Mercy Hospital checking on claim status.
[AGENT][NEUTRAL] OK, [PII], you're needing to check claim status. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And how many claims, er, do you have one?
[CUSTOMER][NEUTRAL] Only one
[AGENT][NEUTRAL] Yes, I can help you. And what is your patient's policy number?
[CUSTOMER][NEUTRAL] 01828764.
[AGENT][POSITIVE] Thank you. One moment, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information that I provide for you, [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, beyond
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is the name again? I'm sorry?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for him, please?
[CUSTOMER][NEUTRAL] [PII]. $664.91.
[AGENT][NEUTRAL] 66, excuse me, 664.91. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] OK, so this claim was received, [PII].
[AGENT][NEUTRAL] The receipt date is [PII].
[AGENT][NEUTRAL] The process date was [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 355.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 692-3.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEGATIVE] This claim was denied.
[AGENT][NEUTRAL] And the reason for the denial, just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The reason for the denial states benefits have been applied to the $1000 calendar year deductible.
[CUSTOMER][NEUTRAL] OK. Uh $412.24 deductible?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you please send the EOB to us through fax?
[AGENT][NEUTRAL] We uh you also have the ability to print it directly from our portal, [PII], by going to secured.
[CUSTOMER][POSITIVE] Yes, yes, I actually.
[CUSTOMER][NEUTRAL] Actually, we got the UOB also. But in, in the UOB, it is stating that claim services information has been building error. So it is not uh mentioned as a patient's responsibility deductible.
[AGENT][NEUTRAL] Yes, so we do not, OK, we do not determine patient responsibility, so it will not say that on our explanation of benefits. It will indicate that the amount was applied to the calendar year deductible.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Yeah. And for that, at least, uh, for, for reference. So can you please send it, send it to us or else to, can you please send it to the providers? Yeah, we don't have that one.
[AGENT][NEUTRAL] So you do not have it?
[AGENT][NEUTRAL] Oh, I'm sorry. I thought you said you did have the explanation of benefits.
[CUSTOMER][NEUTRAL] Yeah, actually, but we, it was not indicating as uh the patient's calendar deductable.
[AGENT][NEUTRAL] On page 2, what is the remark?
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Actually, here the remark uh is remit code is 016 claim services lacks information or a submission billing error.
[AGENT][NEUTRAL] What did you say? Could you repeat what you said because I did not hear you.
[CUSTOMER][NEUTRAL] Yeah, actually, uh, here's the, the reason for the denial. It is showing as claim services lacks information has been submission building error. So it is not showing as the patient's uh um yes.
[AGENT][NEUTRAL] And that, and that is from American Public Life with that claim number that I just gave you?
[CUSTOMER][NEUTRAL] I, I, yes, claim number is also 3556923.
[CUSTOMER][NEUTRAL] Yeah. So, can you please send it to the mailing address?
[CUSTOMER][NEUTRAL] Or else facts if possible.
[AGENT][NEUTRAL] Just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sorry, what did you say?
[CUSTOMER][NEUTRAL] Can you please send mail us, uh, send us the UOB?
[CUSTOMER][NEUTRAL] Denial letter through fax or mailing address.
[AGENT][NEUTRAL] I will fax it just one moment while it's loading so you do have our portal website also that you could print it from with that remark on it that I gave you?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] Uh, no, actually, portal, I don't have, I will take it right now.
[AGENT][NEUTRAL] Our portal website that you go to is [PII].
[CUSTOMER][POSITIVE] Thank you for
[CUSTOMER][NEUTRAL] In public.
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] And what, uh, does it need to have your name on the fax, [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what is your fax number, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'm gonna repeat that back. [PII].
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, so that has been faxed to you. So provided there's not any type of technical issue, you should be receiving that within, I would say 5 to 10 minutes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank.
[CUSTOMER][POSITIVE] Thank you so much, yes. And may I know the call reference number, please?
[AGENT][NEUTRAL] My name along with today's date.
[CUSTOMER][NEUTRAL] Can you please spell your name for documentation purpose, please?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Last initial [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII],
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] Thank you so much, [PII]. That's all for now.
[AGENT][POSITIVE] OK. Well, if that's all I can help you with, thank you again for calling APL [PII]. I hope you have a nice day.
[CUSTOMER][POSITIVE] You too as well. Thank you. Bye-bye.
[AGENT][NEUTRAL] Mhm. Bye-bye.