AccountId: 011433970860
ContactId: a4d8a026-7855-4966-93a7-a6ce991a4997
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 734780 ms
Total Talk Time (AGENT): 171018 ms
Total Talk Time (CUSTOMER): 221794 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/a4d8a026-7855-4966-93a7-a6ce991a4997_20250415T19:21_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, hello [PII]. This is [PII] from Ireland's Health Services, and I would like to check on some claims status, please.
[AGENT][POSITIVE] OK, I'm happy to check on a claim for you. Can I get the patient policy number?
[CUSTOMER][NEUTRAL] Yes, it is 01823420.
[AGENT][POSITIVE] OK, thank you for that. And do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. May I please have patient name and date of birth?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then what's the date of service?
[CUSTOMER][NEUTRAL] OK, so the
[CUSTOMER][NEUTRAL] Let me see, the first date of service is [PII].
[CUSTOMER][NEUTRAL] [PII] actually for these claims, uh, for this specific patient, the primary EOP was submitted over fax to you so I just wanna make sure that you received them.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And the date of service again was what [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the build them out?
[CUSTOMER][NEUTRAL] 2
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so,
[AGENT][NEUTRAL] It looks like the claim was received and processed on [PII].
[AGENT][NEUTRAL] The claim was denied. Office visits are not covered under the member policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, the policy did not provide any benefits for the services which were incurred, it looks like.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] OK, so in that case, well, due to the, the office visits are not covered on the the patient's plan or policy, so it means that it's members responsibility?
[AGENT][NEUTRAL] We're not able to advise on patient responsibility. That's up to the facility or your provider.
[CUSTOMER][NEUTRAL] Oh, OK, I understand that, no worries. Uh, however, do you have the, the UOB, right?
[AGENT][NEUTRAL] Mhm, yeah, and the claim was denied due to office visits are not covered and the policy did not provide benefits for the services incurred.
[CUSTOMER][NEUTRAL] Oh, OK, and could you please double check when it was processed or reprocessed?
[AGENT][NEUTRAL] [PII] is what I'm showing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]. Perfect. And could you please send us via fax the EOB?
[AGENT][POSITIVE] Absolutely. What's a good fax number?
[CUSTOMER][POSITIVE] Thank you so much. Just wondering, are you able to send them via email as well or just fax?
[AGENT][NEUTRAL] Just facts
[CUSTOMER][NEUTRAL] OK, so the fax number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 541 7. You can put attention to my name that is [PII] I can spell it out for you if you want.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, it is [PII].
[AGENT][POSITIVE] Alright, thank you so much, I. All right, I'll send this over to you. Should be there in the next 5 minutes or so.
[CUSTOMER][NEUTRAL] OK, perfect, [PII], and actually could you please take a look on the other claims for this member?
[AGENT][NEUTRAL] What's the next data of service?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] All right. And the uh build amount on that?
[CUSTOMER][NEUTRAL] It is 158.
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] Right, in the meantime, so in this case, because I was checking on the history about these claims, and the records, says that
[CUSTOMER][NEUTRAL] And you were needing the primary EOB, so you don't need it, right? So far.
[AGENT][NEGATIVE] Correct, that's been received. The claim is just denied. It's not denied for needing an explanation of benefits.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK, so this claim, one moment.
[CUSTOMER][POSITIVE] Mhm, no worries, take your time.
[AGENT][NEUTRAL] OK, so this claim was received, uh, it was denied. Office visits are not covered under the member policy.
[AGENT][NEUTRAL] Uh, the claim was processed and denied [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Perfect. And could you please check, well, could you please add the UB as well to the fax?
[AGENT][POSITIVE] Yeah absolutely let me send this one to you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the other date of service is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the bill amount?
[CUSTOMER][NEUTRAL] Mil amount 224.
[AGENT][NEUTRAL] Let me just uh finish this fax here and I'll check that date for you. One moment.
[CUSTOMER][POSITIVE] OK, sure. Thank you.
[AGENT][NEUTRAL] All right, so it looks like we did receive this claim. Uh, claim was denied [PII]. Uh looks like same denial, office visits are not covered under the member policy.
[CUSTOMER][POSITIVE] OK. Thank you.
[CUSTOMER][NEUTRAL] And please add that one as well, to the facts.
[AGENT][POSITIVE] OK, I will send that one as well. Is there anything else I can check on for you?
[CUSTOMER][NEUTRAL] Yes, there's only one claim left for this member that is [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] And the bill amount?
[CUSTOMER][NEUTRAL] It is $2440.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] The day
[CUSTOMER][NEUTRAL] Very.
[AGENT][NEUTRAL] OK, so for this claim, it looks like we're still needing
[AGENT][NEGATIVE] An explanation of benefits, excuse me, uh, for the date of service, it doesn't show that that's been received.
[CUSTOMER][NEUTRAL] Oh, OK, I understand that. um, what's the fax number I can send them over to you.
[AGENT][NEUTRAL] That would be [PII].
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] 19.
[CUSTOMER][POSITIVE] 942 3. Perfect.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK. Well, it's kind of weird because, well, for these 4 claims, um, all the EOBs were sent at the same time. However, well, no worries, I will be resubmitting the EOB, OK, for this specific claim. And do I need to put attention to anyone, or?
[AGENT][NEUTRAL] Uh just attention claims, yeah.
[CUSTOMER][NEUTRAL] Just claims.
[CUSTOMER][POSITIVE] OK. Attention claims, perfect. OK, [PII], well, that's all I needed to know so far. I appreciate your help and patience. And do you have a reference number, [PII]?
[AGENT][NEUTRAL] Absolutely call references my name with my last initial then today's date. My name again is [PII], that's [PII]
[AGENT][NEUTRAL] Initial to my last name is [PII], and then today's date.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] OK, perfect, sir. Well, I appreciate your help again and thank you so much. Have a nice day. Bye-bye.
[AGENT][NEUTRAL] You too Iber bye bye.