AccountId: 011433970860
ContactId: e3443f75-3d35-4d5d-9dcb-ffbd6c64dc89
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1648670 ms
Total Talk Time (AGENT): 415422 ms
Total Talk Time (CUSTOMER): 254600 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/e3443f75-3d35-4d5d-9dcb-ffbd6c64dc89_20250204T13:08_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning, [PII]. My name is [PII]. Last initial is [PII] calling from Mercy Hospital, checking on claim status.
[AGENT][NEUTRAL] OK, [PII], you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][POSITIVE] Thank you. [PII].
[AGENT][NEUTRAL] [PII], is that correct?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And how many claims, [PII], do you have to check status on?
[CUSTOMER][NEUTRAL] 4 claims I have.
[AGENT][NEUTRAL] OK, is it for 4 different patients or for 1 patient and 4 days of service?
[CUSTOMER][NEUTRAL] Uh, for different patients.
[AGENT][NEUTRAL] OK, [PII], so a couple of things up front, um, any information that I provide for you on any of the claims will be a verification of benefits and not a guarantee of payment. You will use my name and the first initial to my last name is [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Along with today's date is your call reference number for each.
[AGENT][NEUTRAL] And lastly, if you, [PII].
[CUSTOMER][NEUTRAL] [PII] and [PII]?
[AGENT][NEUTRAL] With a [PII].
[CUSTOMER][NEUTRAL] Sorry, can you please spell it?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Uh-huh. And then if that we do have the claims on file and you need a copy of any of the explanation of benefits.
[AGENT][NEUTRAL] You will go to our portal at [PII] to print those.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is your first patient's policy number, [PII]?
[CUSTOMER][NEUTRAL] Uh, it is 7, sorry. Uh, policy number is 01828752.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] OK. Again, your phone number you said was [PII]?
[CUSTOMER][NEUTRAL] No, [PII].
[AGENT][NEUTRAL] [PII] are the last four numbers?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK. And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, [PII], [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount?
[CUSTOMER][NEUTRAL] $952024487 even.
[AGENT][NEUTRAL] 95 2024 for 487.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so this claim was received [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Processed and denied on 10-23-2024.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 3521095.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the reason for the denials, right, give me just one moment for [PII] is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Benefits have been applied to the $1000 calendar year deductible.
[CUSTOMER][NEUTRAL] $301 and $994 deductible.
[AGENT][NEUTRAL] That is
[AGENT][NEUTRAL] $301.94.
[CUSTOMER][NEUTRAL] OK. So members deductible.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And can you please send the UOB through fax?
[AGENT][NEUTRAL] Yes, sir. I gave you our fax our.
[AGENT][NEUTRAL] Website
[AGENT][NEUTRAL] To print your EOB from using the claim number that I gave you?
[CUSTOMER][NEUTRAL] Yeah. Oh yeah.
[CUSTOMER][NEGATIVE] Yes, uh, stress, I tried, but I wasn't, but, but my, uh, I tried, but I was unable to create the logins. And so that is why I have called you.
[CUSTOMER][NEUTRAL] So can you please provide us and only for 2 members because
[AGENT][NEUTRAL] Just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you've tried since I gave you the claim number sometimes it won't locate it [PII] with the claim number, but it will once you have that.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let
[AGENT][NEUTRAL] See if I can get it to load.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's going to take a, a couple of minutes for this to get pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Does the vaccine to be put to your attention, [PII], or is that not necessary?
[CUSTOMER][NEUTRAL] Uh, please put my attention.
[AGENT][NEUTRAL] And it was Peter W as in whiskey, is that correct?
[CUSTOMER][POSITIVE] I, uh, yes, that is correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is your fax number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, that, again, that was.
[AGENT][NEUTRAL] [PII]. Is that correct?
[CUSTOMER][POSITIVE] Uh yes, correct. Yes, correct.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And is that the only data service for this number?
[CUSTOMER][NEUTRAL] Uh, yes, for this number, this is the last claim, and I'm ready for the next number.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and the next patient policy number?
[CUSTOMER][NEUTRAL] OK. Next question policy number is
[CUSTOMER][NEUTRAL] 628. 0 yes, uh it is.
[CUSTOMER][NEUTRAL] 01828760.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, please um [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] [PII]. What was the date again? I'm sorry.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] or [PII], I'm not, I'm sorry, I'm having.
[CUSTOMER][NEUTRAL] 1, yeah, [PII].
[AGENT][NEUTRAL] [PII]. OK, thank you.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And the date of service and total bill amount for him, please.
[CUSTOMER][NEUTRAL] [PII] $1,592.15.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so this claim was received. It was received on [PII]?
[AGENT][NEUTRAL] Processed and denied on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 352.
[AGENT][NEUTRAL] 1080.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The reason for the denial states this claim is a duplicate. A previously submitted claim where the benefits have been applied to the policy deductible.
[CUSTOMER][NEUTRAL] OK. And the original claim number is 3 may I know the original claim number?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Make your
[AGENT][NEUTRAL] The original claim number is going to be received 624-2024, processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That claim number is 347.
[AGENT][NEUTRAL] 393 7.
[CUSTOMER][NEUTRAL] OK. And uh, if you don't know, can you please send the original EOB?
[CUSTOMER][NEUTRAL] Through fax. Same previous fax number.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's still loading the information.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you need any additional information on this one?
[CUSTOMER][NEUTRAL] Uh, only originally roaming. That's it for this number.
[AGENT][NEUTRAL] OK, so just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and the next member's policy number please?
[CUSTOMER][NEUTRAL] OK. Next member.
[CUSTOMER][NEUTRAL] Policy ID is 01828786.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], tell me one more time your callback number [PII]. And what are the last four numbers?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is your patient's name and date of birth on this one?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount for him please.
[CUSTOMER][NEUTRAL] Uh, [PII] $365 even.
[AGENT][NEUTRAL] 355 or 365?
[CUSTOMER][NEUTRAL] 365.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] This claim was received on [PII] processed on [PII].
[AGENT][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One second, [PII]:15 2024. Claim number is 3517626.
[AGENT][NEUTRAL] This claim was states denied.
[AGENT][NEUTRAL] And the reason for the denial on this claim states that benefits have been applied to the $1000 calendar year deductible.
[AGENT][NEUTRAL] And that then is 226.30.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Process with uh deductable.
[CUSTOMER][NEUTRAL] And also, can you please send the your registration?
[AGENT][NEUTRAL] You also need the EOB on this one?
[CUSTOMER][NEUTRAL] Yeah. Uh, yes, [PII], please.
[AGENT][NEUTRAL] It's still loading.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And what is your last patient's policy number?
[CUSTOMER][NEUTRAL] OK. Last member ID is 01828903.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Data service, excuse me, data service and total bill amount.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 923 2024 $255 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEGATIVE] OK, so I'm getting these messages that are giving me an error as far and then now I just received one that says one has gone through to you but it's been saying the line is busy.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you did say it was 9-232024 for 255. Is that correct?
[CUSTOMER][POSITIVE] Uh yes, correct, yes.
[AGENT][NEUTRAL] OK, so you said the total bill amount is 255, but I don't see a claim on file for him for that data service and that total bill amount.
[CUSTOMER][NEUTRAL] OK. And also we have sent a paper claim on [PII].
[AGENT][NEUTRAL] Again, we do not have a claim on file for him for that bill amount. 255, is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh yes, correct.
[AGENT][NEUTRAL] Yes, sir, we don't have a claim for that total bill amount.
[CUSTOMER][NEUTRAL] OK. May I know the effective date and termination date of the plan, please?
[AGENT][NEUTRAL] Effective date is [PII] excuse me, [PII].
[AGENT][NEUTRAL] And it is still active, no termination date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And may I know the pay ID?
[AGENT][NEUTRAL] And we will have
[AGENT][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] May I know the payer ID please?
[AGENT][NEUTRAL] Verify
[AGENT][NEUTRAL] 60801.
[AGENT][NEUTRAL] And we must also have a copy of the primary insurance company's explanation of benefits sent along with the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure. OK.
[CUSTOMER][NEUTRAL] OK. And may I know the mailing address, please?
[AGENT][NEUTRAL] OK, what address do you show on file, [PII]?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] What address do you have? You said that you all had already mailed it.
[CUSTOMER][NEUTRAL] Uh, yeah, yeah, yeah. Yeah, [PII].
[AGENT][POSITIVE] That is correct, uh huh.
[CUSTOMER][NEUTRAL] OK. And time refunding limit is?
[AGENT][NEGATIVE] There is no timely filing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah. Thank you so much, [PII]. That's all for now.
[AGENT][POSITIVE] Well, you're very welcome. OK. Well, if that's all then that I can help you with today, thank you again, [PII], for calling APL and I hope you have a great day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah, yeah.