AccountId: 011433970860
ContactId: d589b07d-dede-486f-b5d3-3bf8a4c97de6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 900450 ms
Total Talk Time (AGENT): 375525 ms
Total Talk Time (CUSTOMER): 188850 ms
Interruptions: 4
Overall Sentiment: AGENT=0.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/d589b07d-dede-486f-b5d3-3bf8a4c97de6_20250618T18:27_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling on behalf of Blessing Hospital. I'm checking on the claim status.
[AGENT][NEUTRAL] OK. And did you say your name is [PII]? Is that correct?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, and you're needing to check status on one claim, is that also correct?
[CUSTOMER][NEUTRAL] Uh yes, actually for to claim for the same member.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, 2 claims for the same number. OK, yes ma'am, I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII] direct line.
[AGENT][NEUTRAL] OK, thank you. And the member's policy number, please.
[CUSTOMER][NEUTRAL] Policy number is 02138628.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] One moment please while I get the member's information pulled up.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Oh, you're very welcome.
[AGENT][NEUTRAL] And any information the payment 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] Mhm.
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and what is the first date of service and total bill amount for her place?
[CUSTOMER][NEUTRAL] Uh, it's, uh, first date of service is [PII] with charge amount $946.62.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so this claim was received. The received date was [PII].
[AGENT][NEUTRAL] And it was processed and denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is going to be 357-724-9.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the reason for the denial, [PII] on this claim, it states.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] The calendar year maximum for outpatient accident and sickness treatment in the emergency room has been met.
[CUSTOMER][NEUTRAL] Uh, so,
[AGENT][NEUTRAL] Yes, ma'am, because this is not major medical insurance.
[CUSTOMER][NEUTRAL] Uh, the the calendar max.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The calendar year maximum for outpatient accident and sickness treatment in the emergency room has been met.
[CUSTOMER][NEUTRAL] Uh, so is this gonna be patients responsibility?
[AGENT][NEUTRAL] We do not determine patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, no problem, thank you. Um, is it possible if I could get a copy of the EOB? I'm trying to sign up in the um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] In the portal, but it's stating an error whenever I
[CUSTOMER][NEUTRAL] Input the tax ID.
[AGENT][NEUTRAL] And what is the tax ID number you're using?
[CUSTOMER][NEUTRAL] I am using [PII].
[AGENT][NEUTRAL] OK, yes ma'am, that is the correct number that we're showing.
[AGENT][NEUTRAL] On the, on the system.
[AGENT][NEUTRAL] So what is your error message stating when you enter that tax ID?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEGATIVE] No user found in the information that has been entered.
[AGENT][NEUTRAL] OK, [PII], give me just a second to look at um just see if I can help you with this and
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] This 1 may be one that I just have to fax. Some of these types of policies.
[AGENT][NEGATIVE] It is harder to locate and to sign up to get access.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] For these particular types of claims, but give me just a moment to pull some information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so let, let me just try and walk through the steps with you to see.
[AGENT][NEUTRAL] If we can get this um set up but I'm, I will still fax this to you but I just wanna see if we're able to do it together, OK?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] OK, so first off you selected create your OSC account.
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] OK, hold that. Yes, could you do it.
[AGENT][NEUTRAL] Yeah, just like to
[AGENT][NEUTRAL] OSC account OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then from there, um, it should
[AGENT][NEUTRAL] You you would select I'm a provider or provider.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And then next.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, done.
[AGENT][NEUTRAL] OK. And so what do you see on that screen?
[AGENT][NEUTRAL] After you selected
[CUSTOMER][NEUTRAL] Provide the following information provider account.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Tax ID.
[AGENT][NEUTRAL] OK, and so, right.
[AGENT][NEUTRAL] So you entered that tax ID number that you just gave to me, is that correct?
[CUSTOMER][NEUTRAL] Ah yes, it's still showing where.
[AGENT][NEUTRAL] And your email address?
[AGENT][NEUTRAL] Yes, tax ID and then.
[CUSTOMER][NEUTRAL] Uh, there's no email address.
[AGENT][NEUTRAL] OK, do you see a space on your screen that says email?
[AGENT][NEUTRAL] Is that correct? Is there any?
[CUSTOMER][NEUTRAL] Uh, there's no email.
[AGENT][NEGATIVE] OK, you don't have an email or you don't even see a space on the screen for an email?
[CUSTOMER][NEGATIVE] There's no screen or be showing to uh type in email.
[AGENT][NEUTRAL] OK, alright. So 1 2nd.
[AGENT][NEUTRAL] OK, so it's just the tax ID correct? I'm sorry. I was looking at the wrong thing, [PII]. I'm sorry. OK, so when you enter that, that's when you're getting.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] And now when you're entering that just out of curiosity because since we've made some updates to the portal very recently I'm not super familiar with all of the changes at this point. So when you're entering the tax ID number do you have to put the the hyphen in it or is it just the entire number together?
[CUSTOMER][NEUTRAL] I just entered the entire number.
[AGENT][NEUTRAL] OK, so I truly think that that has to do with the type of policy that this is because that is the correct tax ID number that I'm also looking at.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, so you're doing everything correctly. So give me just a moment.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] To pull this explanation of benefits up and I'll I'll fax it to you, OK?
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] Oh, you're welcome.
[AGENT][NEUTRAL] You can go ahead and give me your fax number please.
[CUSTOMER][NEUTRAL] Uh, yes, it's 844.
[CUSTOMER][NEUTRAL] 3661014.
[AGENT][NEUTRAL] And does it need to be put to your attention, [PII]?
[CUSTOMER][NEUTRAL] Yes, yes I.
[AGENT][NEUTRAL] It does? OK.
[AGENT][NEUTRAL] OK, so just a moment, it takes a moment to load.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it just needs to uh have attention, [PII], is that correct?
[CUSTOMER][POSITIVE] Uh yes, correct.
[AGENT][NEUTRAL] And again you said that your fax number is [PII]. Is that correct?
[CUSTOMER][POSITIVE] Yes. Correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so that, that one has just been sent to you.
[CUSTOMER][POSITIVE] OK. Thank you so much. For the last.
[AGENT][NEUTRAL] And then you uh you're welcome, and you said you had another data service for this number, is that right?
[CUSTOMER][NEUTRAL] Uh yes. Uh, it's the same date of service, but the charge amount is $6,451.74.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so this claim was also received. It was received the same date, [PII].
[AGENT][NEUTRAL] Processed and denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And this one was denied for the same reason as the other.
[AGENT][NEUTRAL] Claim
[CUSTOMER][NEUTRAL] OK. May I know the claim number for this?
[AGENT][NEUTRAL] You can, uh, sure. It's 357-7.
[AGENT][NEUTRAL] 244.
[AGENT][NEUTRAL] And do you need this one?
[CUSTOMER][NEUTRAL] Can I also get a copy of the UB?
[AGENT][NEUTRAL] One moment while it loads.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] All right, thanks so much.
[AGENT][POSITIVE] Uh, you're welcome.
[AGENT][POSITIVE] OK, so I have just faxed you that one also, so provided that there's not any type of technical glitch, [PII], you should be receiving both of those very soon.
[CUSTOMER][NEUTRAL] Thank you so much. Um, if we disagree with the decision, may I know the timely filing for, uh, reconsideration or appeal?
[AGENT][NEUTRAL] An appeal must be filed in writing within 180 days from the date of the decision and sent to attention appeals department.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, is there a fax number or?
[CUSTOMER][NEUTRAL] It will be sent by email.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] It can be faxed, but again, it must be clearly stated that it is for an appeal and it's put to attention appeals department and the claims uh fax number.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That you would send it to is [PII] attention appeals.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Alright, thank you so much for your assistance.
[AGENT][POSITIVE] You're very welcome. So is there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] That's all for today. May I have a full reference, please?
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Yes ma'am. OK. Well, you're very. Yes ma'am. You're very welcome, [PII]. It was my pleasure in speaking to you and thank you again for calling APL. I hope you have a nice rest of your day.
[CUSTOMER][POSITIVE] Thank you so much for your assistance, really appreciate it.
[CUSTOMER][POSITIVE] You too. Bye-bye. Stay safe.
[AGENT][POSITIVE] Thank you. You too. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.