AccountId: 011433970860
ContactId: 8f5e82d8-8107-4ae4-92f9-d3c25eb4a8c0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 555039 ms
Total Talk Time (AGENT): 163033 ms
Total Talk Time (CUSTOMER): 142785 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/8f5e82d8-8107-4ae4-92f9-d3c25eb4a8c0_20250107T16:20_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, [PII]. Uh, this is [PII].
[CUSTOMER][NEUTRAL] I'm calling from provider's office and the Pen County Medical Center.
[AGENT][NEUTRAL] OK. Hi [PII], um, can I please get your callback number?
[CUSTOMER][NEUTRAL] Yeah. Yeah.
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][POSITIVE] OK, thank you, [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Uh, actually, [PII], I'm looking for the claim status and uh I'm not sure like you have transferred me to the another department of the patient, [PII].
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, I had you had you called just a little bit ago.
[CUSTOMER][NEUTRAL] Uh, yeah, actually, [PII], uh, they are I think that like the
[CUSTOMER][NEUTRAL] Yeah, yeah. Actually, they are just stating that that particularly this claim has been uh like handled by the APO department only. So she transferred my call to APO again. So they are saying that uh ask them to search the patient with the name and date of birth so that they can find the patient, patient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, OK. So you spell the name [PII]?
[AGENT][NEUTRAL] And how do I spell the last name?
[CUSTOMER][POSITIVE] Yeah, correct.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] OK, and then his birthday was
[AGENT][NEUTRAL] What's the date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, let me see if I can find him, sir.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yeah, no problem. Take your time.
[AGENT][NEUTRAL] OK, I have him pulled up um let me see, he's got several different policies but they're no longer active. um, what kind of claim is this? is it dental hospital indemnity, accident?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, this is a medical claim.
[AGENT][NEUTRAL] Medical, OK. So it'll be the hospital indemnity.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and then what is the data service for [PII]?
[CUSTOMER][NEUTRAL] Yeah, it was for [PII] with the total charges of $192.
[AGENT][NEUTRAL] OK, and what's the name of the facility you're calling from, sir?
[CUSTOMER][NEUTRAL] Yeah, it's for, it's like, it's Hannepin County Medical Center.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold I'm gonna search for that claim for you, Will, and I'll be right back.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 3535609.
[AGENT][POSITIVE] OK, thank you so much for holding for me, Will. I did find the claim uh let me give you the claim number.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's 353-560-9 and the claim was denied um let me read to you the remarks. It's a non-covered place of service under the outpatient sickness writer this policy covers treatment by physician.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For a covered sickness in the physician's office, clinic, urgent care facility, or emergency room. According to the information on file, services were not rendered in a covered place of service. Therefore, no benefits are payable.
[CUSTOMER][NEUTRAL] OK. Like as per patient plan, the outpatient services are not covered, right?
[AGENT][NEUTRAL] Right, um, for the patient's plan, it was a uh.
[AGENT][NEUTRAL] Non-covered place of service.
[CUSTOMER][NEUTRAL] OK, no problem. Uh, got it. Thank you so much. And, uh, [PII], uh, sorry, sorry, uh, this claim was denied, uh.
[CUSTOMER][NEUTRAL] On, like, do you have any date when was this claim denied?
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes sir, I can look that up for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, we received the claim on [PII].
[AGENT][NEUTRAL] And we processed it also on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. It was on the same date. OK, got it. Thank you so much. And unfortunately, we did not receive any explanation of benefit uh for this claim, uh, until unless like we have to bill to the claim. So like we cannot bill the patient until we do not have the explanation benefit from the insurance. So I would really appreciate if you can uh fax it to me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um what is your fax number, Will?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold. I'm gonna go ahead and send that back to you while we're on the phone together.
[CUSTOMER][POSITIVE] Sure, no problem
[AGENT][POSITIVE] OK, thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me Will I've got that fax on the way to you now.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][POSITIVE] Oh thank you so much [PII] and I really appreciate the effort you made for me and lastly I'm just looking for the uh call reference number.
[AGENT][NEUTRAL] Yes sir, you can use my name and today's date.
[CUSTOMER][NEUTRAL] OK. Uh, like how your name would be pronunciate. It, it would be like, uh, how it would be spelled [PII], right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] OK, thank you so much, sorry, and I really appreciate the effort you made for me and have a nice day ahead.
[AGENT][POSITIVE] You too will thank you for calling APL you have a blessed day.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] You too. Bye-bye.