AccountId: 011433970860
ContactId: e265a585-30f7-4adf-a10c-3f28f90f3aab
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 231479 ms
Total Talk Time (AGENT): 111776 ms
Total Talk Time (CUSTOMER): 92477 ms
Interruptions: 0
Overall Sentiment: AGENT=2.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/e265a585-30f7-4adf-a10c-3f28f90f3aab_20250109T16:56_UTC.wav
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[AGENT][POSITIVE] Hi, thank you so much for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hello, uh, my name is [PII] calling from the Mayo Clinic trying to check on a claim for a patient of ours, please.
[AGENT][POSITIVE] OK, yeah, I'd love to help you with that today, Ms. [PII], and do you mind if I also go ahead and get a good call back number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you so much. I appreciate that and the member's policy number?
[CUSTOMER][NEUTRAL] 002494967
[AGENT][NEUTRAL] All right. 002494967. Did I get that correct?
[CUSTOMER][NEUTRAL] They're all fathers
[CUSTOMER][NEUTRAL] And there could be a 01 at the end.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] I think when I pulled it up on availity I didn't put that in there but it does show it on here when I'm looking at the claim so.
[AGENT][POSITIVE] Yeah, absolutely, and I'm so sorry. um, I don't know what I did, but I lost that whole number. Would you mind repeating it for me?
[CUSTOMER][NEUTRAL] Not a problem. 0024.
[CUSTOMER][NEUTRAL] 94.
[CUSTOMER][NEUTRAL] 967.
[CUSTOMER][NEUTRAL] 01.
[AGENT][POSITIVE] Thank you so much. I really appreciate that.
[AGENT][NEUTRAL] All righty and.
[AGENT][NEUTRAL] Your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Wonderful thank you so much and do you have a claim that you're looking for additional information for or are you trying to get overall like all claim status and you want me to search it by the date of service?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] Well, this one here I've got a claim pulled up in on uh availity and it says it processed and.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Back on the there was a check date of [PII], but I don't know that we received the denial and it says for more detailed information, see remittance advice as to why it denied.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, but it doesn't tell me what it denied for.
[AGENT][NEUTRAL] OK, so it doesn't give you the remittance. OK, so these claims for this particular policy, they all get processed through a company called Web TPA and so I can't see the claims. I like I could tell you if the policy is effective, but like that's as much as I can do, um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But if I can give you the contact number for web TPA and they should be able to let you know what the reasons for the claim denial are.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and the phone number?
[CUSTOMER][NEUTRAL] Usually it's the other way around because usually they just reprice things and then you guys pay stuff but OK.
[CUSTOMER][NEUTRAL] Your set up is a little different.
[AGENT][NEUTRAL] Yeah, this one's kind of I'm I it's the only company that does this but yeah this one's a little different um.
[CUSTOMER][NEUTRAL] OK, all right.
[AGENT][NEUTRAL] And their phone number is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, I will give them a call.
[AGENT][POSITIVE] All right. Well, I wish you the best of luck, Miss [PII], and I hope you have an excellent day and you stay warm out there.
[CUSTOMER][NEUTRAL] You as well, is there a uh reference number for our call today?
[AGENT][NEUTRAL] You betcha. It's my name, [PII], last name, [PII], and today's date.
[CUSTOMER][POSITIVE] Perfect thanks so much for your help I really appreciate it.
[AGENT][POSITIVE] It's my pleasure. You take care. Thank you.
[CUSTOMER][NEUTRAL] Yep bye now.
[AGENT][NEUTRAL] Bye bye.