AccountId: 011433970860
ContactId: cc0d655c-e51c-444c-8e63-92bb246741c1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 354739 ms
Total Talk Time (AGENT): 152084 ms
Total Talk Time (CUSTOMER): 113615 ms
Interruptions: 1
Overall Sentiment: AGENT=1.7, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/cc0d655c-e51c-444c-8e63-92bb246741c1_20250304T14:19_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], this is [PII] from Holy Cross Hospital. I'm checking status on the claim.
[AGENT][NEUTRAL] OK, did you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] The callback number is [PII], direct.
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] The uh.
[CUSTOMER][NEUTRAL] 02509854.
[AGENT][NEUTRAL] 09854. Was that correct?
[CUSTOMER][NEUTRAL] Wait, wait, 02509854.
[AGENT][POSITIVE] Yes ma'am. OK, thank you.
[CUSTOMER][NEUTRAL] And who am I speaking to?
[AGENT][NEUTRAL] Again, my name is [PII].
[CUSTOMER][NEUTRAL] What's your last initial [PII]?
[AGENT][NEUTRAL] S and yours?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And DD, any information that I provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] by [PII].
[AGENT][NEUTRAL] OK, thank you. And the date of service and total bill amount for her, please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um, 176 $63.25.
[AGENT][NEUTRAL] OK, thank you one moment. And what is her first name again?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so let's see, this claim has been received multiple times. The last 3 times it's been denied as a duplicate of previously submitted expenses. Give me just one moment. Yes, ma'am. Give me just a moment and I'll get that information for you.
[CUSTOMER][NEUTRAL] So, what was the original denial then? Yeah, I was gonna say what's the original.
[CUSTOMER][NEUTRAL] Because they did resubmit the claim.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Also got rejectedated and I don't say why.
[CUSTOMER][NEUTRAL] Oh claim review.
[AGENT][NEUTRAL] OK, so the original claim was received, uh, let's see, it was received on [PII].
[AGENT][NEUTRAL] And it was processed on [PII].
[AGENT][NEUTRAL] The claim number is 352-6218.
[AGENT][NEUTRAL] There was a benefit paid in the amount of $1,107.84.
[CUSTOMER][NEUTRAL] Say it again. It was paid to what?
[AGENT][NEUTRAL] $1,107.84 on single check 2011998.
[CUSTOMER][NEUTRAL] Say it again, 201.
[AGENT][NEUTRAL] 1998.
[CUSTOMER][NEUTRAL] Uh, let me see, do we receive that?
[CUSTOMER][NEGATIVE] Yeah, we received that, but they turned around.
[CUSTOMER][NEUTRAL] Oh, cause it was underpayment.
[AGENT][NEUTRAL] This policy only helps with co-pays, deductibles, and co-insurance amounts.
[AGENT][NEUTRAL] Of covered services.
[CUSTOMER][NEUTRAL] Oh, only, only, only, OK, only covers.
[AGENT][NEUTRAL] Mhm. Copay, co-pays, deductibles and co-insurance amounts of covered services.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, copay, deductibles and co-insurance you said?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And if you need a copy of this explanation of benefits data, you can print that from our portal by going to [PII].
[CUSTOMER][NEUTRAL] Insurance.
[CUSTOMER][NEUTRAL] OK, only covers copay top of the car insurance benefits, um.
[AGENT][NEUTRAL] Yes, ma'am, because this is only a supplemental policy to their primary insurance.
[CUSTOMER][NEUTRAL] Oh, supplemental.
[CUSTOMER][NEUTRAL] So for me.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Policy.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Did they build a secondary, let me see.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] So I need to be calling in.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, um, I just need a reference for the call.
[AGENT][NEUTRAL] Sure, you would use my name along with today's date.
[CUSTOMER][NEUTRAL] Oh, OK, so, uh.
[CUSTOMER][POSITIVE] OK, Ms. [PII], uh, have a good day.
[AGENT][POSITIVE] All right, baby. Yes, ma'am, you too. Is there anything else at first that I could help you with?
[CUSTOMER][NEUTRAL] No, that's all.
[AGENT][POSITIVE] All right. Well, thank you again for calling APL and I hope you have a great day too.
[CUSTOMER][NEUTRAL] Alright, you too.
[AGENT][POSITIVE] Thanks.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye.