AccountId: 011433970860
ContactId: 9da0f923-23c7-4e1f-b045-8bba9a0169bd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 451170 ms
Total Talk Time (AGENT): 202777 ms
Total Talk Time (CUSTOMER): 118067 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=2.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/9da0f923-23c7-4e1f-b045-8bba9a0169bd_20250109T19:36_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. I'm [PII] calling from Baptist Memorial Hospital. I'm looking for a client status. How are you doing today?
[AGENT][POSITIVE] I'm doing well, [PII]. Thank you for asking. How are you doing today?
[CUSTOMER][POSITIVE] Pretty well, thanks for asking me.
[AGENT][NEUTRAL] Well, good. How can, and you're needing claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Alright, thank you, if you'll bear with me just one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], what is a good callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] The patient's ID is 910113.
[AGENT][NEUTRAL] And what is the patient's name and date of birth, please, ma'am?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] All right. Thank you.
[AGENT][POSITIVE] And it would be my pleasure to assist you with that claim status. What is the date of service?
[CUSTOMER][POSITIVE] Mhm. You're welcome.
[CUSTOMER][POSITIVE] I'm happy to know that. And the date of service is [PII] and the total bill amount is $213 even.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And you said date service [PII]?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Yeah, that's right.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the facility name please ma'am?
[CUSTOMER][NEUTRAL] Oxford Diagnostic Center.
[AGENT][POSITIVE] All right, thank you. It would be my pleasure to assist you with that claim status. We did receive that claim, and if you, we received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you for that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim was denied as this policy provides no benefits for the treatment of conditions other than a sickness or injury.
[AGENT][NEUTRAL] So it's a non-covered diagnosis.
[CUSTOMER][NEUTRAL] May I know what is the covered service?
[AGENT][NEUTRAL] This policy pays towards sickness or injury.
[AGENT][NEGATIVE] Not for wellness.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, got it. Is that the member's liability the amount?
[AGENT][NEUTRAL] I do apologize. Can you repeat that?
[CUSTOMER][NEUTRAL] Can we bill the patient for the non-covered amount?
[AGENT][NEUTRAL] And we don't determine patient responsibility. We're not major medical. Therefore, we do not determine patient responsibility. That will be determined by the provider.
[CUSTOMER][NEUTRAL] OK, got it. Can I get the claim number, please?
[AGENT][NEUTRAL] The claim number is 3411168.
[CUSTOMER][POSITIVE] Thank you. Can I get a copy of your way, please?
[AGENT][NEUTRAL] ELBs are obtainable on our portal at [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Got it. Uh thank you for that information. And I do have one more claim for a different member. If you don't mind, could you please help me with that?
[AGENT][POSITIVE] [PII], it would be a pleasure to assist you with another claim status today. What is that policy number, please, ma'am?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much for that. And the next number ID is 793215.
[AGENT][NEUTRAL] And what is that patient's name and date of birth, please, ma'am?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And what is that data service?
[CUSTOMER][POSITIVE] Mhm. You're welcome.
[CUSTOMER][NEUTRAL] The date of service is [PII] and the total bill amount is $4,064 even.
[AGENT][NEUTRAL] Is it for the same facility, [PII]?
[CUSTOMER][NEUTRAL] One moment, let me check that for you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah, it is under the same facility.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][POSITIVE] Mhm. You're welcome.
[AGENT][NEUTRAL] We received that claim.
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And process on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And this claim was denied.
[AGENT][NEUTRAL] Let me check the denial reason.
[AGENT][NEUTRAL] So that looks like a duplicate. Let me find the original. I apologize.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Bear with me just one second, let me get the original claim information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, [PII], the original claim.
[AGENT][NEUTRAL] We received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the amount of 17,820.
[AGENT][NEUTRAL] Was applied to the $1000 calendar year deductible on this plan.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I can give you that claim number as well.
[CUSTOMER][NEUTRAL] OK. Can I get that?
[AGENT][NEUTRAL] The claim number is 232.
[AGENT][NEUTRAL] 5209.
[CUSTOMER][NEUTRAL] Got it. May I know how much does the patient already met?
[AGENT][NEUTRAL] Let me get that for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That was in [PII].
[AGENT][NEUTRAL] [PII] $338.20 of her $1000 calendar year deductible.
[CUSTOMER][NEUTRAL] $337 right?
[AGENT][NEUTRAL] And 20 cents.
[CUSTOMER][POSITIVE] Got it. Thank you so much for all this information. For this one also, you can be obtained through uh through the portal, right?
[AGENT][POSITIVE] Yes, ma'am. That is correct.
[CUSTOMER][POSITIVE] Thank you so much, [PII], and that's all I wanted to know. Can I get the reference number for the conversation, please?
[AGENT][NEUTRAL] The reference number is my name and today's date, [PII], and I spell my name [PII]
[AGENT][NEUTRAL] First initial last name [PII].
[CUSTOMER][POSITIVE] Thank you for that and thank you for your assistance. Have a lovely day.
[AGENT][POSITIVE] And thank you for calling APL. I hope you have a wonderful day as well and thank you for calling APL. Take care.
[CUSTOMER][POSITIVE] Thank you. Bye.
[AGENT][NEUTRAL] Bye bye.