AccountId: 011433970860
ContactId: e85199f5-320e-4a7d-981c-3102cb538f83
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 482579 ms
Total Talk Time (AGENT): 103936 ms
Total Talk Time (CUSTOMER): 74129 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/e85199f5-320e-4a7d-981c-3102cb538f83_20250501T14:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from Prose's office. Look upon a claim status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status, sir. Can I please get your callback number?
[CUSTOMER][NEUTRAL] Sure, that is [PII] and it's a direct line?
[AGENT][NEUTRAL] OK, and then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] And the policy number is 024879448.
[CUSTOMER][NEUTRAL] M [PII]
[CUSTOMER][NEUTRAL] And the patient's name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] OK, let me pull that policy up real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and then can you please give me the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Yes, date of service is [PII] for the bill amount of $324 even.
[AGENT][NEUTRAL] OK, and then what are the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] That's $25.
[AGENT][NEUTRAL] And may I please have the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Yes, that is Holy Cross Medical Group.
[CUSTOMER][NEUTRAL] Uh, so, it's Holy Cross Hospital Medical.
[AGENT][NEUTRAL] OK, thank you so much. OK, [PII], I'm going to put you on a brief hold while I look up this claim for you and I'll be right back, sir.
[CUSTOMER][NEUTRAL] Mhm, yeah.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me, [PII]. So I do have the claim pulled up and let me give you the claim number. It's 35839999.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim was denied for two reasons, uh, the first one being that office visits are not covered under the patient's policy.
[AGENT][NEUTRAL] And then the second one is we do not make payments for charges that are not incurred.
[CUSTOMER][NEUTRAL] And when it was denied,
[AGENT][NEUTRAL] Uh, let me let you know. Let me look it up real quick.
[AGENT][NEUTRAL] We received the claim on [PII] and processed it on [PII].
[CUSTOMER][POSITIVE] Mhm. Thank you so much for that information. And could you please fax me the copy of EOB?
[AGENT][NEUTRAL] Yes, what's your fax number?
[CUSTOMER][NEUTRAL] It's [PII]. And you can send the fax addition to my name.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I get that fax ready for you and I'll be right back sir.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thanks.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Wow
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, [PII]. I've got that fax on its way to you now, sir.
[CUSTOMER][POSITIVE] Mhm, sure, thank you so much for that.
[CUSTOMER][NEUTRAL] And could you please spell your name for me?
[AGENT][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And could you please provide me the call reference number to this call.
[AGENT][NEUTRAL] Yes, you can use my name and today's date.
[CUSTOMER][POSITIVE] Sure, thank you so much for your help today. Have a good rest of today. Bye for now.
[AGENT][POSITIVE] Bye-bye [PII]. Thank you for calling APL. You have a wonderful day too.
[CUSTOMER][NEUTRAL] You too. Bye.