AccountId: 011433970860
ContactId: d09ff3da-fc3b-4426-88bd-da4d4968f4a7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 313029 ms
Total Talk Time (AGENT): 123478 ms
Total Talk Time (CUSTOMER): 114185 ms
Interruptions: 3
Overall Sentiment: AGENT=0.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/d09ff3da-fc3b-4426-88bd-da4d4968f4a7_20250505T17:49_UTC.wav
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[AGENT][NEUTRAL] For calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes [PII], my name is [PII]. I am calling from TJ Simpson Community Hospital. I just wanted to verify if a claim was on file for a patient, please.
[AGENT][NEUTRAL] OK, I can help you with that, uh, [PII], could I get a callback number?
[CUSTOMER][NEUTRAL] Yes [PII].
[AGENT][NEUTRAL] Thank you. The policy number you're calling on?
[CUSTOMER][NEUTRAL] It is 026 03291.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] I guess it's [PII]. I'm not really sure how you pronounce it. Date of birth [PII].
[AGENT][NEUTRAL] OK, thank you so much for uh verifying the policy and you did say you were calling for status today. What is the date of service we're checking?
[CUSTOMER][NEUTRAL] OK date of service is going to be.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The total charges.
[CUSTOMER][NEUTRAL] $878.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] 1
[AGENT][NEUTRAL] OK. And the provider on the claim?
[CUSTOMER][NEUTRAL] OK, the, the facility or the individual provider?
[AGENT][NEUTRAL] So was it billed uh with the provider and the facility?
[CUSTOMER][NEUTRAL] Um, let's see, this one was a 1500, so let me, um, verify, yeah.
[AGENT][NEUTRAL] Oh let's see here so it looks like.
[AGENT][NEUTRAL] I think it's all the same. OK. So it looks like for this uh policy, I'm sorry, for this data service, we made a, uh, the maximum payment of $50 to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, yeah, um, I've seen that we got an ELB for another bill for the same data service for 535, um, but we never got one for the 878, so that's the reason why I was calling.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me total these charges up.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, so the 878 claim, let me see, was not paid, that one was denied. Uh, let me see what the denial reason is here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It may have been denied. Let's see.
[AGENT][NEUTRAL] OK, so the lab, the lab procedures were denied, uh, stating the lab tests are not covered.
[AGENT][NEUTRAL] Um, and then the 36415 procedure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh. Mhm.
[AGENT][NEGATIVE] Was denied.
[AGENT][NEUTRAL] Uh, then puncture, not covered by the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, has there been like any kind of correspondence sent to our facility stating this?
[AGENT][NEUTRAL] Yeah, so on this, it processed the same date as the payment?
[CUSTOMER][NEUTRAL] Oh hang on, I'm like hang on.
[AGENT][NEUTRAL] Uh, so it, you should have received it at the same time you received uh the.
[AGENT][NEUTRAL] Uh, EOB, uh, where we pay the 50, uh, they were both sent out.
[CUSTOMER][NEUTRAL] Yeah, I just found it. I just found, yeah, I just found it as you as you were saying that um it was um under another place that that I didn't look so yeah it says non all that was non covered procedures and so that is patient responsibility correct.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Mhm, correct.
[AGENT][NEUTRAL] Now that is up to the provider. We do not determine patient responsibility that would be left up to the provider.
[CUSTOMER][NEUTRAL] OK, OK then alright then I will go ahead and put this in my notes and um do you all do call reference numbers or no?
[AGENT][NEUTRAL] To reference our call, you will use my name, [PII] and today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, all right then thank you so much you have a good rest of your day.
[AGENT][POSITIVE] You're welcome, [PII]. You have a wonderful day yourself and thank you for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] All right, thank you. All right, thank you, bye bye.