AccountId: 011433970860
ContactId: d3094117-0ede-4397-9e08-178ee7d6df51
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 406690 ms
Total Talk Time (AGENT): 152249 ms
Total Talk Time (CUSTOMER): 127759 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/d3094117-0ede-4397-9e08-178ee7d6df51_20250107T14:34_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, it's uh [PII] calling from University of Alabama Hospital, Birmingham to check on the claim status. Could you please provide your name as well?
[AGENT][NEUTRAL] My name is [PII]. That's [PII]. Last initial is [PII]. And I didn't quite catch your name. Can you repeat your name?
[CUSTOMER][NEUTRAL] Sure. It's [PII]. [PII]. And my last name is [PII].
[AGENT][NEUTRAL] OK, thank you, and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure. It's uh [PII].
[AGENT][NEUTRAL] OK, I didn't get the first digits. Can you repeat the first digits?
[CUSTOMER][NEUTRAL] [PII]. Yeah.
[AGENT][NEUTRAL] [PII]. OK.
[AGENT][NEUTRAL] [PII]. OK, thank you. All right, and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Sure, it's 1073734.
[AGENT][POSITIVE] OK, thank you. Um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] It's uh [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Mm thank you. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yeah, the data service is 1030 2024 with the bill amount of uh $1,049 1049.
[AGENT][NEUTRAL] OK. All right, let me see if I can find this claim for future. You can check claim status online through our website at [PII], and you said the date of service was [PII], correct?
[CUSTOMER][NEUTRAL] Yeah, [PII], [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, let me pull this be one moment.
[AGENT][NEUTRAL] OK, I'm still waiting on the AOB to pull up. OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] So you have received the claim, right?
[AGENT][NEUTRAL] Um, yes, we did.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so it looks like we received the claim on [PII] process [PII].
[CUSTOMER][NEUTRAL] And uh with it on.
[AGENT][NEUTRAL] Received on [PII].
[CUSTOMER][NEUTRAL] OK. And uh process on?
[AGENT][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, the claim was denied. The denial reason.
[CUSTOMER][NEUTRAL] Claim number? Claim number, please?
[AGENT][NEUTRAL] Oh, claim number is 354.
[AGENT][NEUTRAL] 0995.
[CUSTOMER][NEUTRAL] 354-099-95, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And it's the night?
[AGENT][NEUTRAL] The denial reason mhm let me know when you're ready.
[CUSTOMER][NEUTRAL] Yeah, what are the, the reason, sir?
[AGENT][NEUTRAL] OK, that is that um policy does not provide benefits for labs or diagnostic tests.
[CUSTOMER][NEUTRAL] Did you?
[AGENT][NEUTRAL] Policy does not provide benefits for laboratory or diagnostic tests.
[CUSTOMER][NEUTRAL] Policy does not cover?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Does not provide benefits or cover laboratory.
[CUSTOMER][NEGATIVE] Sorry, I'm not able to hear you properly. Your voice is breaking you just repeat that?
[AGENT][NEUTRAL] Policy does not provide benefits. The policy does not cover lab or diagnostic tests.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Lab or diagnostic test.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So this is the reason.
[AGENT][NEUTRAL] That is the denial reason.
[AGENT][NEUTRAL] So it's a non-covered service.
[CUSTOMER][NEUTRAL] OK, one moment. Could you please be on hold for a moment?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Thank you sir.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, thank you for holding. So you mentioned that uh can be made for policy not cover or not handle the lab or diagnostic test. So this is a patient responsibility, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um, it's on the provider's discretion. We don't have any contractual involvement on the remaining of the claim. Um, we're not the major medical.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Hello, hello. OK, so the primary process and the
[AGENT][NEUTRAL] This is a limited policy.
[CUSTOMER][NEUTRAL] Yeah, the primary process can pay the amount that the remaining is $30.85 which is the patient responsibility. And you mentioned that uh your insurance is not uh covering the labor diagnostics. So we need to bill the patient, right, for that amount?
[AGENT][NEUTRAL] It's up to the provider's discretion.
[CUSTOMER][NEUTRAL] Since that is not that.
[CUSTOMER][NEUTRAL] OK. Thank you for that. And could you please provide me the color?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date.
[CUSTOMER][NEUTRAL] So, I'm, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] 172025. Thank you for that.
[AGENT][NEUTRAL] Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, just check. One moment, please.
[AGENT][NEUTRAL] Mr.
[AGENT][NEUTRAL] OK, sure.
[CUSTOMER][POSITIVE] OK. Thank you for providing these details. Have a wonderful day.
[AGENT][POSITIVE] You as well thank you for calling APL mhm bye bye.
[CUSTOMER][NEUTRAL] Bye bye.