AccountId: 011433970860
ContactId: a8ce6c88-9611-4eee-95b7-237d739cbc39
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 510829 ms
Total Talk Time (AGENT): 177535 ms
Total Talk Time (CUSTOMER): 260532 ms
Interruptions: 3
Overall Sentiment: AGENT=1.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/a8ce6c88-9611-4eee-95b7-237d739cbc39_20250217T15:26_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm sorry I had you on mute.
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Sorry.
[CUSTOMER][POSITIVE] Um, my name's [PII], and I need, yeah, I appreciate that. Oh goodness, um, my name's [PII], and I'm, I'm, uh, needing to speak to you about, uh, patients claims, please.
[AGENT][NEUTRAL] I was waiting for you.
[AGENT][POSITIVE] It would be my pleasure to assist you, [PII], and happy Monday morning. What's that callback number?
[CUSTOMER][POSITIVE] Yes, absolutely.
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] 01941094
[AGENT][NEUTRAL] All right, thank you. And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII] and it's [PII].
[AGENT][POSITIVE] All right, thank you, and it would be my pleasure to assist you with that claim information. Do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] I don't have the on the first one I don't have a claim number. I have um data service 6-13-2024.
[AGENT][NEUTRAL] And the bill out, please, ma'am.
[CUSTOMER][NEUTRAL] $84?
[AGENT][NEUTRAL] And the facility name.
[CUSTOMER][NEUTRAL] It is Saint Genevieve County Memorial Hospital, and it's underneath the clinic name of uh Bloomsdale Family Health.
[AGENT][POSITIVE] Oh perfect thank you.
[AGENT][NEUTRAL] I can help you with that claim information, [PII]. That claim.
[CUSTOMER][NEUTRAL] So I guess my mhm go ahead.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] No, you're fine yeah, claim number.
[AGENT][NEUTRAL] The claim number is 353.
[AGENT][NEUTRAL] 462 9.
[CUSTOMER][NEUTRAL] OK, and um was and it processed and what is it?
[AGENT][NEUTRAL] Yeah, we received yeah we received that claim on.
[AGENT][NEUTRAL] 1125 24 and processed on [PII]. It was denied because office visits are not covered under the patient's plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All office visits or um like all um sorry I'm trying to type to uh all office outpatient um outpatient, OK, and what is covered underneath the plan? Is it just inpatient benefits or or is it procedures or what kind of plan is this?
[AGENT][NEUTRAL] I understand.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] So it's inpatient hospitalization and outpatient facilities such as outpatient surgery and then hospital facility or surgical center, um.
[AGENT][NEUTRAL] Emergency room.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] It has to be billed as an outpatient facility.
[CUSTOMER][NEUTRAL] Got you, not the clinic, OK, OK.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] All right. And so,
[CUSTOMER][NEUTRAL] We didn't get an an EOB quite yet for this particular claim that I uh that data service. Is there any way that I can uh request the the list of the claims that we have for the denial so then we can go ahead and bill the patient?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yeah, you want the easiest way to get those EOBs? I can help you.
[CUSTOMER][NEUTRAL] Well, I have the website access, but on the, the ones uh I didn't check this particular claim on there um but is that an availability type of a situation where that we can.
[AGENT][POSITIVE] Absolutely. If you put that, um, you wanna check and make sure real quick?
[CUSTOMER][NEUTRAL] OK, let me
[CUSTOMER][NEGATIVE] Yeah, let me, let me, I'm gonna, 00, that's not what I wanna do.
[CUSTOMER][NEUTRAL] I'm gonna put you on speaker just one second. Hold on so I can I I.
[AGENT][NEUTRAL] Go right ahead.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] So I am going into the quick access right?
[AGENT][POSITIVE] Mhm. Quick access. That's right.
[CUSTOMER][NEUTRAL] OK, and I'm gonna put that claim number that you gave me in.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Patient's first name.
[CUSTOMER][NEUTRAL] Date of birth.
[CUSTOMER][NEUTRAL] Alright, and then let's see.
[CUSTOMER][NEUTRAL] 0 claims bound.
[AGENT][NEUTRAL] Really?
[CUSTOMER][NEUTRAL] Yeah, so I, that's why I called. OK, so make, I'm just gonna make sure that I have the right um website because, well, I, I.
[AGENT][NEUTRAL] Tax number, yeah, and tax number.
[CUSTOMER][NEUTRAL] So I've got the [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then it's the hashtag and then the log in with the little flashes so I'm not sure what the deal is here.
[AGENT][NEUTRAL] Are you under that um same tax ID number?
[CUSTOMER][NEUTRAL] Yeah, I, that's for all of our providers, so that's what I would have registered myself under.
[AGENT][NEUTRAL] And you put
[CUSTOMER][NEUTRAL] It doesn't ask for tax ID either, so.
[AGENT][NEUTRAL] So do you have several different tax ID numbers that you check? I'm wondering if you created an account under this tax ID.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, I don't, uh, we only have one tax ID number.
[AGENT][NEUTRAL] You wanna verify it? Let me just make sure we have it correct.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Mhm. Mhm.
[AGENT][NEUTRAL] Hm, that's correct. And the patient's account number? I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] And just make sure
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I just wanna make sure I have I I the claim number that you gave me is 3534629, right?
[AGENT][POSITIVE] Yeah, that's right.
[CUSTOMER][NEGATIVE] So I don't know what the deal is, it's, but it's coming up 0 claims bound.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] And whenever I try the first name, you know, don't have a claim number, uh.
[AGENT][NEUTRAL] Oh, you know, you know what? I bet you just put [PII].
[AGENT][NEUTRAL] Did you put [PII] dash [PII]?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] That's what we have his first name listed as, see if that works.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] It's searching. Oh there it is. OK, OK, perfect, perfect, OK.
[AGENT][POSITIVE] We figured it out, yay.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh great, I will go online then here and download these EOBs. I'm, I'm, let me just make sure that I have that access real quick. It's, it's loading the it's loading the claim information.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] That's actually quicker than us faxing it to us, to you.
[CUSTOMER][POSITIVE] Well, good to know.
[CUSTOMER][NEUTRAL] Yeah, most likely, yeah, OK, so I'm gonna make a note that online we have to do the dash deer. OK, perfect. Um, OK, yep, and there it is, right, pretty as you please. OK.
[AGENT][POSITIVE] See, I would have said dieter. I'm so glad you said needed.
[CUSTOMER][POSITIVE] All right, well thank you so much and is there a uh call reference number please?
[AGENT][POSITIVE] Call reference number is my name and today's date, and I spell my name [PII]. And it's been such a pleasure to assist you with that claim information, [PII]. Anything else I can help you with today?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Nope, I think we got it covered now. Thank you so much.
[AGENT][POSITIVE] And thank you for calling APL. I hope you have a wonderful day. Take care. Thank you. Bye-bye.
[CUSTOMER][POSITIVE] Yes, ma'am. You too. Thanks. Bye.