AccountId: 011433970860
ContactId: a02f07c6-cfd3-4d0e-b8bb-dd02c2121e1d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 817750 ms
Total Talk Time (AGENT): 214247 ms
Total Talk Time (CUSTOMER): 169173 ms
Interruptions: 4
Overall Sentiment: AGENT=1.1, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/a02f07c6-cfd3-4d0e-b8bb-dd02c2121e1d_20250508T13:25_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APO. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good morning. How are you? Uh, my name is [PII], and I'm calling you for, um, I don't have a claim on file for a patient, so I'm calling to follow up with if you guys have the claim.
[AGENT][POSITIVE] I'm good
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, sure, yes, I can assist you with claims, Ms. [PII]. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Of course, [PII].
[AGENT][NEUTRAL] Thank you. And you're calling from which facility from my location?
[CUSTOMER][NEUTRAL] I'm calling for Moses Cophysician Services.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number? OK.
[CUSTOMER][NEUTRAL] The hospital.
[CUSTOMER][NEUTRAL] Yeah, it is uh 945137.
[AGENT][NEUTRAL] I'm sorry, I don't think I got this right. There was 945937.
[CUSTOMER][NEUTRAL] 94 9 9451 37.
[AGENT][NEUTRAL] 137, OK.
[CUSTOMER][POSITIVE] It's all right.
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Of course, the name is [PII]. Date of birth [PII].
[AGENT][POSITIVE] Perfect, thank you. And may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] It is, um, date of service will be [PII] for the amount of 175. Medicare pay and process and remaining balance for you guys $50.
[AGENT][NEUTRAL] OK, let's see if I can find that claim.
[AGENT][NEUTRAL] And now it's [PII]. OK.
[AGENT][NEUTRAL] OK, for future, you can check claim status online through our website at [PII] and that's just optional. And bear with me just a minute, let me pull this ELP.
[AGENT][NEUTRAL] That's for procedure code 99213.
[CUSTOMER][POSITIVE] Correct. Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm still waiting on the EOB to upload, OK, one moment.
[CUSTOMER][POSITIVE] I take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] All right, here we go. OK, looks like we processed the claim on [PII] and the claim was denied. Um, the reason for this denial is.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] I'm so sorry, sir. Now why it's taking so long to upload.
[CUSTOMER][NEUTRAL] Maybe it's like um no coverage date of service or you guys can cover the service.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] More than likely it's gonna be non-covered. Let me see. Um, this particular policy is going to be one of our, let's see, secondary supplemental plan, yes, and it looks like the maximum of 3 urgent care visits for
[CUSTOMER][NEUTRAL] Are you guys uh super mental?
[CUSTOMER][NEUTRAL] Oh, you, you.
[CUSTOMER][NEGATIVE] You guys don't cover me, I noticed that supplemental doesn't cover United Healthcare, only main, main, only the main Medicare, right?
[AGENT][NEUTRAL] We cover after the major medical.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Mhm. In this case, it looks like it was denied because the, the policy has 3 urgent care visits per year and he already assessed his benefit.
[CUSTOMER][NEUTRAL] Mm, OK. Can you fax me the UV?
[AGENT][NEUTRAL] Um, yeah, what is the fax number?
[CUSTOMER][NEUTRAL] Yeah, it is um
[CUSTOMER][NEUTRAL] [PII]. And can you please also add the invoice number? Um, it's um uh Alpha [PII] 117.
[CUSTOMER][NEUTRAL] 4175051. I'll repeat the number. [PII], I'm sorry, Alpha [PII].
[CUSTOMER][NEUTRAL] 117417
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 5051.
[CUSTOMER][NEUTRAL] And can I also have the claim number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, sure, the claim number is 3558344.
[AGENT][NEUTRAL] And uh let me repeat this information, Ms. [PII]. OK, so I have a um
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The fax number is [PII] and you want me to put attention AP 1174175051?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, and my name.
[AGENT][NEUTRAL] So you want uh that number and your name. Do you want your name first or after the number?
[CUSTOMER][NEUTRAL] Yes, please.
[CUSTOMER][POSITIVE] Oh, you can, whatever you want, doesn't matter.
[AGENT][NEUTRAL] OK. All right. Do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][NEUTRAL] You're gonna have to
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Do you mind holding for me while I send this out to you? OK. OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Yeah, you can leave, put me on hold. Yes, of course, yeah.
[CUSTOMER][POSITIVE] Thank you. Yes.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me Ms. [PII]. Yeah, I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh, yeah, so when, when was it processed and your name and to end the reference call?
[AGENT][NEUTRAL] OK, um, let me pull that. OK, so it was processed on [PII].
[AGENT][NEUTRAL] And my name is [PII]. That's [PII]. Last initial [PII].
[CUSTOMER][NEUTRAL] OK. And.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. And today's date?
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] Uh one question, so it was received on the [PII] and processed on the [PII], the same day, right?
[AGENT][NEUTRAL] No, let me give you the receipt date. That's not on the EOB. One moment.
[AGENT][NEUTRAL] OK, that's it's all right, no problem. Uh, we received on the [PII], the process on [PII]. Mhm.
[CUSTOMER][NEUTRAL] I'm sorry, I just have to put those notes there. Oh yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. I just put that on the note. Thank you on the [PII]. Thank you so I appreciate oh let me see if I have one more. Give me a quick second.
[AGENT][NEUTRAL] It's OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, sure, yes, take your time.
[CUSTOMER][NEUTRAL] Uh, no, so that would be the only one.
[AGENT][NEUTRAL] OK.
[CUSTOMER][MIXED] Too bad. You guys have good customer service.
[AGENT][POSITIVE] Thank you so much. You have a good day, Ms. [PII].
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Like, yeah, yeah.
[CUSTOMER][POSITIVE] Thank you, Miss O. Have an amazing day.
[AGENT][POSITIVE] My pleasure. Thank you. You too. Mm bye-bye.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mm