AccountId: 011433970860
ContactId: 9bee0b0d-1ce7-405e-a2d2-5fdd6cef6ebc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 733390 ms
Total Talk Time (AGENT): 265397 ms
Total Talk Time (CUSTOMER): 144345 ms
Interruptions: 4
Overall Sentiment: AGENT=1.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/9bee0b0d-1ce7-405e-a2d2-5fdd6cef6ebc_20250403T12:58_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] Hi, [PII]. Good morning. My name is [PII]. I'm the provider facility. My facility name is Baptist Memorial Hospital. May I know the claim status?
[AGENT][NEUTRAL] OK, you're needing to check claim status for one member?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is that correct? Two different patients or 2 dates of service for the same patient?
[CUSTOMER][NEUTRAL] Different.
[AGENT][NEUTRAL] Different patients.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes ma'am, I can help you and if you could please spell your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], OK, thank you. And your callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, can you repeat your phone number?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so again, the phone number is area code [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you, and [PII], you would use my name along with today's date as your call reference number for each one.
[AGENT][NEUTRAL] Also, any information that I provide for you today on the claims would be a verification of benefits and not a guarantee of payment and lastly if we do have the claims on file and you need a copy of the explanation of benefits, once you have the claim number, you should be able to print those from our portal.
[AGENT][NEUTRAL] By going to secured.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] AM
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is your first patient's policy number, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 960812.
[AGENT][NEUTRAL] Did you say 960812? Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information, I, well, giving you that, but any information on either claim would be a verification of benefits and not a guarantee of payment. So what is your patient's name on this policy and date of birth?
[CUSTOMER][NEUTRAL] Patient's first name is [PII]. Last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] And the date of service and total bill amount for her place.
[CUSTOMER][NEUTRAL] [PII] $1,535 even.
[AGENT][NEUTRAL] OK, your voice, your voice wasn't audible. What is the date of service?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. Is that correct?
[CUSTOMER][NEUTRAL] No, [PII].
[AGENT][NEUTRAL] OK, and the bill amount?
[CUSTOMER][NEUTRAL] $1,535 even.
[AGENT][POSITIVE] OK, thank
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so after this claim was received.
[AGENT][NEUTRAL] The claim was received on [PII].
[AGENT][NEUTRAL] It was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 345.
[AGENT][NEUTRAL] 7
[AGENT][NEUTRAL] F
[AGENT][NEUTRAL] 39.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the reason for the denial on this claim states that services were rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] Yes. For that, we send letters to the patient need to update the actual coverage information. Did you receive any response from the patient side?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] This policy is no longer active with APL as one.
[CUSTOMER][NEGATIVE] Your voice is breaking.
[AGENT][NEUTRAL] This policy actually terminated with APL as of [PII]. She did not have any active coverage.
[AGENT][NEUTRAL] with our company for your date of service.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK. Still, we have not received the uh explanation of bandwidth uh we need uh to be patient.
[AGENT][NEUTRAL] Yes, ma'am. So you, you may print that.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Sure, you may print print that from the portal that I get.
[CUSTOMER][NEGATIVE] Your voice is breaking.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes ma'am, the portal website that I gave you, now that you have the claim number, you may print that from our portal if you need a copy of it.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Please provide me that portal.
[AGENT][NEUTRAL] Do you need for me to repeat that because I gave you that initially when we got on the call. Do you need for me to give that to you again?
[CUSTOMER][NEUTRAL] Uh, please provide me that portal name.
[AGENT][POSITIVE] Secured.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][POSITIVE] Yes, ma'am. You're very welcome.
[CUSTOMER][NEUTRAL] Call reference number, your name and the date, right?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Call reference number is your name and the date, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] OK. Thank you so much for that. Could you please check the next number?
[AGENT][NEUTRAL] One moment, please.
[AGENT][NEUTRAL] OK, and the next member's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] 982-519.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] First name is [PII], last name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And the date of service and total bill amount please.
[CUSTOMER][NEUTRAL] [PII] $829 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] No
[AGENT][NEUTRAL] Just one moment, please.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] OK. So yes, ma'am, this claim was also received, [PII].
[AGENT][NEUTRAL] The received date is [PII].
[AGENT][NEUTRAL] It was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 345.
[AGENT][NEUTRAL] 0587.
[AGENT][NEUTRAL] And this claim was denied for the same reason.
[AGENT][NEUTRAL] It states these services were rendered after coverage was terminated.
[AGENT][NEUTRAL] This policy had a term date of [PII].
[CUSTOMER][NEUTRAL] OK. For this also, I need the EOB. I downloading portal.
[AGENT][NEUTRAL] Yes, ma'am, and the same portal. I have the same portal is where you would print that from.
[CUSTOMER][POSITIVE] OK, [PII]. Thank you so much. Have a great day. Bye for now.
[AGENT][POSITIVE] Yes certainly will. Yes, ma'am. Is there anything I could help you with this morning?
[CUSTOMER][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] OK. Well then, thank you again for call.
[AGENT][POSITIVE] OK, you're welcome thank you again for calling.
[AGENT][POSITIVE] On APL. Have a great day.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Uh-huh, bye bye.