AccountId: 011433970860
ContactId: ef98813f-d778-487d-9201-06bfde9ca0b0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 773590 ms
Total Talk Time (AGENT): 187000 ms
Total Talk Time (CUSTOMER): 112810 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/ef98813f-d778-487d-9201-06bfde9ca0b0_20250204T18:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh hello, my name is [PII] and I'm calling from Mercy Clinic Southeast and I'm looking for a claim status.
[AGENT][NEUTRAL] What is your callback number, [PII], if disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] What is the policy number?
[CUSTOMER][NEUTRAL] 650641
[AGENT][NEUTRAL] OK, the policy number is 650641. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] First name is [PII] and the last name is [PII], and date of birth is [PII].
[AGENT][NEUTRAL] OK, I have that number pulled up and you're calling for claim status. You can also check claim status by visiting our secure portal that's [PII], and on that website you're able to obtain an EOB if you need one. Again on that website you can get the EOB. And what's the date of service and total charge amount please?
[CUSTOMER][NEUTRAL] [PII] and bill amount is $185 even.
[AGENT][POSITIVE] $185 even. thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I do not show a claim on file for [PII] for $185 even.
[CUSTOMER][NEUTRAL] $1,085 even.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] OK, I did not show that claim on file, [PII].
[CUSTOMER][NEUTRAL] Uh, I have a claim number. Can you check it with that?
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] 353
[CUSTOMER][NEUTRAL] 2498.
[AGENT][NEUTRAL] OK, I have that claim pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And how can I help you?
[CUSTOMER][NEUTRAL] Yeah, I'm looking for a general claim status.
[AGENT][NEUTRAL] I do not show a claim that was submitted by the excuse me, by the provider for this state of service for that bill amount.
[CUSTOMER][NEUTRAL] So you don't, uh, do not have any claim.
[AGENT][NEUTRAL] I have a claim on file but it was not submitted by the provider.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So who submitted this claim?
[AGENT][NEUTRAL] I'm not able to give you the information. I'm not able to give that information to you, but it was not sent by the provider.
[CUSTOMER][NEUTRAL] But this claim was submitted by a provider. Let me check on which date it was submitted. It was submitted on [PII].
[AGENT][NEUTRAL] [PII]. OK.
[CUSTOMER][NEUTRAL] Yeah. And uh let me check.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm. And it was received on [PII].
[AGENT][NEUTRAL] Number [PII].
[AGENT][NEUTRAL] Give me 1 2nd.
[AGENT][NEUTRAL] To see if we have that plan submitted by the provider. One moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] 1,018 $1,185.
[AGENT][NEUTRAL] And again, that was $1,185 is that correct?
[CUSTOMER][NEUTRAL] 1085.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, I do show that claim was received. My apologies. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 2
[CUSTOMER][NEUTRAL] Uh, can you speak loudly?
[AGENT][NEUTRAL] Of course, I show the claim was received on [PII] and processed on [PII].
[AGENT][NEUTRAL] I show that we did receive the claim from the provider.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there any payment on this claim?
[AGENT][NEUTRAL] I will have to send this claim back for review, um.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Give me one sec. Can I place you on hold? Can I place you on hold? Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, yeah, but uh uh I want to know one thing why this claim is needs to send back for review.
[AGENT][NEUTRAL] I'm sorry, [PII], I said the claim may be have to have to be sent back for review if you would hold the line for me please.
[CUSTOMER][NEUTRAL] Uh, sure, so OK.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII] how may I help you?
[AGENT][NEUTRAL] Hi [PII], how did I get you?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I, I was calling for the HR department and how did I get you, [PII]? Wow, OK, well.
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][NEUTRAL] OK, well, never mind, um.
[CUSTOMER][NEUTRAL] Probably because
[CUSTOMER][POSITIVE] It might be because we're doing HI calls now maybe and it's rolling to us.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] But for like claims information they uh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] We first initial call I believe I I don't know I'm a little confused because we just started it on Monday.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK. Oh, OK.
[AGENT][NEUTRAL] Wow, OK. So I'll actually need to speak to the actual.
[CUSTOMER][NEUTRAL] But, but go ahead, let me help you.
[AGENT][NEUTRAL] No, actually I needed to speak with the, uh, an adjuster. That's why I was calling, so you would not be able to assist me with this, OK? You would not be able to assist me with this, but thank you anyway, [PII], you have a good one.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEGATIVE] Gotcha.
[CUSTOMER][POSITIVE] All righty.
[CUSTOMER][POSITIVE] You too, [PII]. Thank you. Bye bye.
[AGENT][NEUTRAL] OK, right, right, bye-bye.
[AGENT][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] Hello, [PII], [PII], please. Are you there? OK, thank you so much. Thank you so much for your patience. OK, thank you. I will have to send the claim back to be reviewed. Um, again, that was claim number, the claim number you provided me is 353-2498. So that has to be reviewed and please allow time for that to be reviewed and reprocessed.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. May I have your name, please?
[AGENT][NEUTRAL] My name, of course, my name is [PII]. My last initial is [PII], and today's date for the reference, please, [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII]. That's all for the day. Have a good day. Bye for now.
[AGENT][POSITIVE] Alright, thanks for calling AP. Take care bye bye.