AccountId: 011433970860
ContactId: 8f117c6c-27fd-438f-ac9b-f38acb4a236c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 748219 ms
Total Talk Time (AGENT): 185693 ms
Total Talk Time (CUSTOMER): 132689 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/8f117c6c-27fd-438f-ac9b-f38acb4a236c_20250110T15:56_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm [PII] calling from Baptist Memorial Hospital. I'm looking for a claim status. How are you doing today?
[AGENT][POSITIVE] I'm doing well, Miss [PII] how are you doing today?
[CUSTOMER][POSITIVE] Pretty well, thanks for asking me.
[AGENT][NEUTRAL] OK Miss [PII], I can help you with the claim status. Can you please give me your callback number just in case the call gets disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure, it is [PII].
[AGENT][POSITIVE] Thank you so much and then what is the patient's name?
[CUSTOMER][NEUTRAL] Sure. Uh, the patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, and what is [PII]'s policy number?
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] 967957.
[AGENT][NEUTRAL] OK, let me look that up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and then what is the date of service for [PII]?
[CUSTOMER][NEUTRAL] It is [PII] and the total bill amount is $647 even.
[AGENT][NEUTRAL] OK, thank you and then what is the amount after the primary insurance paid their part?
[CUSTOMER][NEGATIVE] But I don't see any primary fare for the member.
[AGENT][NEUTRAL] OK, alright, I'll look it up without that and you said you're calling from Baptist Memorial Hospital, is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK Miss [PII], I'm gonna put you on a brief hold while I look this claim up for you and I'll be right back.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi [PII], this is [PII] back with you again, um, checking on claim number 3,334,400.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim was denied because the dependent is no longer eligible on the policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it. Can I get the policy effective on term date, please?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] The effective date is I'm sorry, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the policy lapsed on [PII].
[CUSTOMER][NEUTRAL] But uh during the date of service, the member's policy is active. May I know why the claim denied like that?
[AGENT][NEUTRAL] Because the dependent.
[AGENT][NEGATIVE] I no longer eligible.
[CUSTOMER][NEUTRAL] May I know when the dependent is uh uh ineligible?
[AGENT][NEUTRAL] Uh, let me look and see if I could see in the notes when he was dropped.
[AGENT][NEUTRAL] The dependent was dropped on.
[AGENT][NEUTRAL] Let's see family.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Got it. Thank you so much for all this information. Can I get a copy of your it please?
[AGENT][NEUTRAL] Yes um can I get your fax number please and I'll send that EOB to you.
[CUSTOMER][NEUTRAL] OK. Uh, the fax number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, I'm
[AGENT][NEUTRAL] Gonna put you on a brief hold while I fax that over to you while you're on the phone with me. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, [PII] that fax is on its way to you.
[CUSTOMER][POSITIVE] Got it. Thank you so much for that information. And I do have uh one more claim for a different member. If you don't mind, could you please help me with that?
[AGENT][NEUTRAL] Yes, I can help you with another claim. What is the member's name?
[CUSTOMER][NEUTRAL] Sure. The member's name is [PII].
[AGENT][NEUTRAL] OK and and what's [PII]'s policy number?
[CUSTOMER][NEUTRAL] And the ID is
[CUSTOMER][NEUTRAL] 02030115
[AGENT][NEUTRAL] OK, and then what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, let me pull in that policy real quick.
[AGENT][NEUTRAL] OK, and then what is the date of service?
[CUSTOMER][NEUTRAL] Date of service is [PII] and the total bill amount is $5590.22.
[AGENT][NEUTRAL] OK and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] The patient responsibility from the primary is $725.62.
[AGENT][NEUTRAL] OK, and is it for the same facility for the Baptist Memorial Hospital?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold again so I can look this claim up for you. I'll be right back.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me, Miss [PII]. So looking for data service [PII], I do not find a claim on file for that amount.
[CUSTOMER][NEUTRAL] Mm. Mhm.
[CUSTOMER][NEUTRAL] Got it. May I know the policy effective on term date, please?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] The effective date is [PII] and the policy is still active.
[CUSTOMER][NEUTRAL] Got it. May I know the claiming address and the pay ID?
[AGENT][NEUTRAL] The payer ID is 60801.
[AGENT][NEUTRAL] The claim address is APL Claims, that's [PII] Box 248,950, Oklahoma [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it. Thank you for that. And may I know the time calling limit, please?
[AGENT][NEUTRAL] There isn't one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it. Thanks for that. And can I get the reference number for our conversation, please?
[AGENT][NEUTRAL] Yes, ma'am. You can use my name, [PII], and today's date.
[CUSTOMER][POSITIVE] Got it. Thank you for that and thank you for your assistance. Have a lovely day.
[AGENT][POSITIVE] You have a great weekend Miss [PII], and thank you for calling APL.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][POSITIVE] Thank you. Bye.