AccountId: 011433970860
ContactId: d8acae55-44f5-4ddc-82f4-faf2bae5c57a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1063920 ms
Total Talk Time (AGENT): 218687 ms
Total Talk Time (CUSTOMER): 161102 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/d8acae55-44f5-4ddc-82f4-faf2bae5c57a_20250306T17:14_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[AGENT][NEUTRAL] You.
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from AC Hospital looking for a claim status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. May I get your callback number, sir, just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Sure, callback number [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] The ID number 01963639.
[CUSTOMER][NEUTRAL] No's name, [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] OK, let me pull up that policy for us real quick.
[AGENT][NEUTRAL] OK, and then what is the date of service and the charge amount for the claim?
[CUSTOMER][NEUTRAL] Yeah, I have 3 claims for this situation. First date of service I have [PII].
[CUSTOMER][NEUTRAL] And the build amount $576 even.
[AGENT][NEUTRAL] OK and then what is the charge amount after the prime?
[AGENT][POSITIVE] Insurance paid their part.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yes one moment please.
[CUSTOMER][NEUTRAL] I have to get the primary UV.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][POSITIVE] Thank you so much for waiting. It's 55 + 83.
[AGENT][POSITIVE] Oh, take your time.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] It's $138.11.
[AGENT][POSITIVE] Thank you. And what is the name of the facility?
[CUSTOMER][NEUTRAL] And the we have Mercy Clinic.
[AGENT][NEUTRAL] Mercy Clinic. OK, I'm gonna put you on a brief hold, [PII], while I look this claim up for you and I will be right back.
[CUSTOMER][NEUTRAL] Sure. Thank you. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, [PII]. I have the claim pulled up.
[AGENT][NEUTRAL] Now, uh, the claim was received on.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Let me make sure I get the right one.
[AGENT][NEUTRAL] Claim was received on [PII].
[AGENT][NEUTRAL] Oil of [PII].
[AGENT][NEUTRAL] And was processed on [PII].
[AGENT][NEUTRAL] And the claim was denied because.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is the calendar year maximum for the policy was met.
[CUSTOMER][NEUTRAL] May I know how much was the annual limit?
[AGENT][NEUTRAL] Uh, yes, they get.
[AGENT][NEUTRAL] Let me look real quick.
[AGENT][NEUTRAL] For outpatient they get $2000 per calendar.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Thank you. Can I have the claim number?
[AGENT][NEUTRAL] Yes, sir. It's 323-1146.
[CUSTOMER][NEUTRAL] Thank you. Is it possible to fax the UP?
[AGENT][NEUTRAL] Sir, I can fax that to you. May I get your fax number?
[CUSTOMER][NEUTRAL] Sure, it's [PII]. Attention [PII], last initial [PII].
[AGENT][NEUTRAL] OK, and that let me repeat it back to you. [PII].
[CUSTOMER][NEUTRAL] It's last [PII].
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] Right? Yeah.
[AGENT][NEUTRAL] Yes, sir. All right, I'm gonna put you on a brief hold while I fax that to you and I'll be right back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh,
[CUSTOMER][POSITIVE] Sure, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] You got the EOB because you gave me the.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] And thank you for holding for me, [PII]. I have that fax on its way to you now.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Sure, thank you so much. I have 2 more claims for the same patient. Can you help me out?
[AGENT][NEUTRAL] Uh, yes, sir. What is the date? Of service?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEGATIVE] And total charges $184 even after primary paid uh the balance $35 even.
[AGENT][NEUTRAL] OK, and is it for the same facility?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'm gonna put you on a hold and look that one up for you and I'll be right back, [PII].
[CUSTOMER][NEUTRAL] Sure. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK [PII], I have this one pulled up for you now. Uh, the claim number is 328.
[AGENT][NEUTRAL] 9304 the claim was denied because office visits are not covered under the patient fee?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And let me get your.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] The received date was [PII].
[AGENT][NEUTRAL] And the process date was [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I have the U will be through the same fax number.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes sir, I'm gonna put you on a brief hold again and um fax that right to you. I'll be right back.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, [PII]. I've got that fax on the way to you now.
[CUSTOMER][NEUTRAL] Thank you, [PII]. Uh, when you're ready, I can provide you the last date of service.
[AGENT][NEUTRAL] The last date of service. Yes, can I please get that?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. And the bill amount $184 after primary paid $35.
[CUSTOMER][NEUTRAL] For the same provider.
[AGENT][NEUTRAL] And same facility sir? OK good alright one last we're gonna hold one more time so I can look this one up. I'll be right back.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Sure. OK. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me, [PII]. So this claim number is 3373062.
[CUSTOMER][NEUTRAL] You're welcome, [PII].
[AGENT][NEUTRAL] Let me find and we received the claim on [PII], processed it on [PII], and the claim was denied for the same reason office visits are not covered by the patients policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Of is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you. Uh, may I have the UV?
[AGENT][NEUTRAL] And I have faxed that to you already. Yes, I faxed it to you already, so I had you on hold.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Thank you. Um, is there a caller reference number for this call?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yes sir, you can use my name [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is there
[CUSTOMER][POSITIVE] OK. Thank you so much for you. That's a lot for you. Thank you so much and have a wonderful day.
[AGENT][POSITIVE] OK, you have a wonderful day too, [PII], thanks for calling APL.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][POSITIVE] Thank you. You're welcome. Bye.