AccountId: 011433970860
ContactId: d375d3da-4eba-42f3-b84d-2cfce214350b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 431239 ms
Total Talk Time (AGENT): 177127 ms
Total Talk Time (CUSTOMER): 125744 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/d375d3da-4eba-42f3-b84d-2cfce214350b_20250217T18:37_UTC.wav
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[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Hey, this is [PII] in customer service. I have a provider's office on the line taking um uh claim status.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's the policy number is 237-0305.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and the lady on the phone, her name is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do you want her callback number?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] In which part?
[CUSTOMER][NEUTRAL] 2, and um she verified his uh date of birth, and she said the date of service was [PII].
[AGENT][NEUTRAL] 2
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I got it.
[CUSTOMER][POSITIVE] All right, here she comes. Thank you.
[AGENT][POSITIVE] Thanks, [PII].
[AGENT][POSITIVE] Appreciate it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, bye.
[AGENT][NEUTRAL] Bye-bye.
[AGENT][POSITIVE] Hi, [PII], this is [PII]. I'll be happy to assist you with the claim status. How are you today?
[CUSTOMER][NEUTRAL] Hi.
[CUSTOMER][POSITIVE] I'm good how are you?
[AGENT][NEUTRAL] I'm good, thanks for asking. May I have the total bill amount for data service 1023 24?
[CUSTOMER][NEUTRAL] Alrighty here of course the account closed on me. Let me find you again.
[CUSTOMER][NEUTRAL] Um, where did it go?
[CUSTOMER][NEUTRAL] Hang on one second, I don't know where it went.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I think I gave well no that's right I think I gave her the wrong name now that I'm looking at it. The number is 0 I'm sorry patient's name.
[CUSTOMER][NEUTRAL] Let's start over. Patient's name is [PII]
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] I gave her a hombrero.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm looking at 1023 of 24.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And total bill or provider's name.
[CUSTOMER][NEUTRAL] So he has two claims, one for 2,325 and then one for 2400. Provider's name is Holy Cross Hospital.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Thank you. For future reference, you may visit our website at [PII] check claim status as well. Let me get this pulled up one moment.
[CUSTOMER][NEUTRAL] I tried and it told me the number was wrong so I so I was like oh I'll call.
[AGENT][NEUTRAL] The provider number?
[CUSTOMER][NEGATIVE] No, the member's ID was wrong.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Oh, OK, well, let's see.
[CUSTOMER][NEUTRAL] So, yeah.
[AGENT][NEUTRAL] Let's get you the claim number and see if that uh help you. Let me get this pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] OK, I'm only showing one for data service 1023 for Albert and it has a different build amount.
[AGENT][NEUTRAL] This is.
[AGENT][NEUTRAL] Holy Cross Hospital.
[CUSTOMER][NEUTRAL] So we mailed in the claims?
[CUSTOMER][NEUTRAL] With the primary EOBs in November.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] This one
[AGENT][NEUTRAL] This one was 3:43. This one was received [PII]. Let me pull up the claim image.
[AGENT][NEGATIVE] Cause this one is way off.
[CUSTOMER][NEGATIVE] Yeah, those aren't even our providers' names.
[CUSTOMER][NEUTRAL] Ours would be a Stephanie and a Giovanni.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Because this is the only one for Holy Cross.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] The system is entirely slow. I do apologize. So this one is for Holy Cross Hospital. It looks like it was a outpatient surgery.
[CUSTOMER][POSITIVE] You're right.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And this bill is
[AGENT][NEGATIVE] Totally different. This is a $68,000 bill.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] What else is out here on that date?
[AGENT][NEUTRAL] OK. So I'm showing the, it looks like anesthesia. So here it is.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So, for
[AGENT][NEUTRAL] The 2325.
[AGENT][NEUTRAL] That one processed under claim number.
[AGENT][NEUTRAL] 3537829
[AGENT][NEUTRAL] This one processed as the max met for the day because this is an outpatient benefit per calendar day max.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And the one for 2400 also processed and denied as the benefit max was met. It looks like the facility bill came in first and maxed the benefit.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] All right, so then the patient is responsible for these.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, alright, and then can I have the claim number for the 2400?
[AGENT][NEUTRAL] Yes, it's 353-783-2. Would you like me to fax them over to you?
[CUSTOMER][NEUTRAL] Yeah, that was my next question.
[AGENT][NEUTRAL] Yes, may I have your fax number?
[CUSTOMER][NEUTRAL] Yep it's [PII].
[AGENT][NEUTRAL] [PII]. I will fax both of these over. Is there anything else I can assist you with, [PII]?
[CUSTOMER][NEUTRAL] Um, no, can you put attention [PII]? We have two Nicols.
[AGENT][POSITIVE] C H O L E, yes ma'am. I'll send it right over.
[CUSTOMER][POSITIVE] All right thank you so much for your help.
[AGENT][POSITIVE] You're so welcome and thank you for calling American Public Life, [PII]. Have a great day. Bye-bye.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] You're welcome. Bye-bye.