AccountId: 011433970860
ContactId: deb0a0a3-421d-4d07-9110-462623d2eaea
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 531059 ms
Total Talk Time (AGENT): 199194 ms
Total Talk Time (CUSTOMER): 144603 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/deb0a0a3-421d-4d07-9110-462623d2eaea_20250305T18:16_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], uh, my name is [PII] Uh last name initial [PII]. I'm calling from Memorial Regional Hospital to check claim status on a patient.
[AGENT][NEUTRAL] OK, you're needing claim status, [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes sir, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII] and it's direct.
[AGENT][NEUTRAL] OK, thank you very much. And what is the member's policy number, please?
[CUSTOMER][NEUTRAL] It's 0188548 ML 7.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] OK, we're missing a number somewhere maybe I just.
[AGENT][NEUTRAL] misheard you. You said 0188548. Is that correct?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Yeah, yes, ML 7.
[AGENT][NEUTRAL] OK, so, yes, sir. Do you have a copy of the ID card, [PII], cause that's not a valid number.
[AGENT][NEGATIVE] Not enough numbers
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, hold on one second because I have a.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I have a correspondence and it tells me.
[AGENT][NEUTRAL] And it would be on there. If it's an is it an explanation of benefits?
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I believe so. Hold on one second. Let me look for it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] 6458.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] You gave me 0188548.
[CUSTOMER][NEUTRAL] OK, I can't.
[CUSTOMER][NEUTRAL] 0188548 ML 7
[AGENT][NEUTRAL] OK. Again, that's.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, hold on one second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Oh my God, I can't I can't find it.
[CUSTOMER][NEGATIVE] I'm gonna have to go back.
[AGENT][NEUTRAL] Well, that's OK. Do you have any other information that I can try and look up the patient with? Do you have the full social of the subscriber?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, I don't. Oh, I can wait. I think I found that. Hold on one second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Policy number is 018854448.
[AGENT][NEUTRAL] 48. So we were missing one of the 4s in the first number you gave me.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, one moment, please.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And any information that I provide for you, [PII], would be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's for [PII]. Her date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her place, [PII]?
[CUSTOMER][NEUTRAL] OK, this is for occupational therapy, so she has 123456 days of service and they're each $580.
[CUSTOMER][NEUTRAL] The first date is [PII].
[CUSTOMER][NEUTRAL] And I keep getting it now saying duplicate.
[AGENT][NEUTRAL] OK. And you said it was $180 is that correct?
[CUSTOMER][NEUTRAL] No, it's 580,580.
[AGENT][NEUTRAL] 580. 580.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] OK, so yes sir we've received this claim more than once and the most recently processed claim was denied as a duplicate. The original claims information, give me just one moment and I'll give you that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, the original claim was received on [PII].
[AGENT][NEUTRAL] And it was processed and denied on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That claim number is 35.
[AGENT][NEUTRAL] 13167.
[AGENT][NEUTRAL] And the reason for the denial on this particular claim?
[AGENT][NEUTRAL] States that kinesiology, speech, or occupational therapy are not covered benefits under this policy.
[CUSTOMER][NEUTRAL] I see. Alright, is there any way that I could uh get a UOB without uh.
[AGENT][POSITIVE] Sure, you can actually print it directly from our portal.
[CUSTOMER][NEUTRAL] I don't have the Social Security number, the last 7, I mean the last 4 numbers, so I can't look it up.
[AGENT][NEUTRAL] OK, can you try it with the claim number that I provided for you just now?
[CUSTOMER][NEUTRAL] Let me try 3.
[AGENT][NEUTRAL] OK. So you do have the secure. [PII] website.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] It it doesn't come up.
[CUSTOMER][NEUTRAL] With the claim number.
[AGENT][NEUTRAL] 351-316-7.
[CUSTOMER][NEUTRAL] Just the claim number of the patient.
[CUSTOMER][NEUTRAL] Yeah, it doesn't show up.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] It's going to take a moment for this information to pull up.
[AGENT][NEUTRAL] Because the portal should give you multiple options for how to look for.
[CUSTOMER][NEUTRAL] Well, the other option would be to add the last four digit of the social, and I don't have that.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEGATIVE] All I need is just one evil being.
[AGENT][NEUTRAL] Give me just, this is still trying to load for me, um, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Still working on it.
[AGENT][NEUTRAL] Will the, will the facts rather need to be put to your attention or is that not necessary?
[CUSTOMER][NEUTRAL] Uh, it's not necessary. Uh, it would be uh 954.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, still loading for just one moment.
[CUSTOMER][POSITIVE] Thank you I appreciate it.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and again, you said the fax is [PII]. Is that correct?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK, so I have just faxed that to you so provided there's not any type of technical problem, you should be receiving that, um, just I would say within probably 10 minutes, provided it's able to go through.
[CUSTOMER][POSITIVE] OK great thank you.
[AGENT][POSITIVE] You're welcome. Absolutely.
[CUSTOMER][POSITIVE] Thank you so much. uh, and can I get a, can I get a phone reference number?
[AGENT][NEUTRAL] You would use my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] Great, thank you. You have a great day. I appreciate it. Take care.
[AGENT][POSITIVE] Oh well, you're certainly welcome. Yes, so that's all I can help you with, [PII]. Thank you again for calling APL and I hope you have a great afternoon.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.