AccountId: 011433970860
ContactId: e4f01951-7635-48df-ab99-66cea484229c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 365519 ms
Total Talk Time (AGENT): 112636 ms
Total Talk Time (CUSTOMER): 154530 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/e4f01951-7635-48df-ab99-66cea484229c_20250204T22:20_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I need to confirm uh the status of a claim for a patient.
[AGENT][NEUTRAL] OK, I can help you with claim status. Can I please get your name and your callback number?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you [PII] and then what is the name of the um patient?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] The patient's name is [PII].
[AGENT][NEUTRAL] OK, and then what is the patient's date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then what is um [PII]'s policy number, please?
[CUSTOMER][NEUTRAL] 01749315
[AGENT][NEUTRAL] OK, let me look up her policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then what is the day's service, please?
[CUSTOMER][NEUTRAL] Uh, [PII] for $267.
[AGENT][NEUTRAL] OK, thank you and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] 0 $90 I believe.
[AGENT][NEUTRAL] OK, and what is the name of the facility you're calling for [PII]?
[CUSTOMER][NEUTRAL] Women's health specialist of North Texas or Waxahatchie Women's Health PA.
[AGENT][NEUTRAL] OK, alright, I'm gonna put you on a brief hold, Miss [PII], while I look up this claim for you and I'll be right back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you, [PII] for holding for me. So looking for data service of [PII], I do not find a claim on file for Miss [PII].
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, OK, let me look at this one real quick. I have, uh, let me just see here.
[CUSTOMER][NEUTRAL] Yeah, I had another. Do you show another, uh, claim on file for the same data service for $239?
[AGENT][NEUTRAL] Let me look um.
[CUSTOMER][NEUTRAL] OK, let me just see if this one because that one's already paid so I'm not but I I don't know how I how that would have happened. They were both sent on the same day.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] Right, for this policy number 1749315, I don't see that Miss [PII] has any claims that that have been filed for her.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, let me just check something real quick.
[CUSTOMER][POSITIVE] Interesting.
[CUSTOMER][NEUTRAL] It's showing this claim as paid and that claim as.
[AGENT][NEUTRAL] Let me see if she has any.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Let me just look here.
[CUSTOMER][NEUTRAL] Other health insurance paid balance due 0. OK, one balance due after the primary paid was 0.1 balance was not. Let me go back to check rejection report here and see if there's a rejected claim for the $90.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] There is a rejected claim. OK, is there a way, let's see, it says payer ID is missing or invalid, is there a way I can fax it, mail it or um any other way besides um.
[CUSTOMER][NEUTRAL] Uh, electronically, can I get it to you?
[AGENT][NEUTRAL] Yes, ma'am. Uh, let me give you the fax number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh it's 1877.
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] 87
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] 65
[CUSTOMER][NEUTRAL] 9423 OK and I can just pick.
[AGENT][NEUTRAL] And then we also have what you.
[CUSTOMER][POSITIVE] Go go ahead honey, I'm sorry.
[AGENT][NEUTRAL] Would you like the mailing address also?
[CUSTOMER][NEUTRAL] Yeah, I'll take it just in case.
[AGENT][NEUTRAL] OK, yes ma'am, um, it'll be [PII].
[AGENT][NEUTRAL] And that's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] That's [PII].
[CUSTOMER][NEUTRAL] OK, see.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] [PII] I was just there yesterday, um, OK, yeah.
[AGENT][POSITIVE] Oh wow.
[CUSTOMER][NEUTRAL] My husband's family lives in [PII], so we just came through there back to [PII], yeah, um, OK, so I'm gonna go ahead and fax it. Do I need to put it to the attention of the claims department on the fax?
[AGENT][POSITIVE] Oh, cool.
[AGENT][NEUTRAL] Oh,
[AGENT][POSITIVE] Yes ma'am, please.
[CUSTOMER][POSITIVE] OK, attention claims, and I'll go ahead and get it sent over and I will get them to check that, uh, payer ID for their system for the payer electronic system. Alright, I appreciate you so much. I'll send that over right away.
[AGENT][POSITIVE] You're very welcome. You're very welcome. You have a, you're welcome. You have a good night. Bye-bye.
[CUSTOMER][POSITIVE] Thank you bye bye.
[CUSTOMER][POSITIVE] Thanks you as well bye bye.
[AGENT][POSITIVE] Thanks for