AccountId: 011433970860
ContactId: f37857f4-96fd-4230-94eb-3de7775356b5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 463230 ms
Total Talk Time (AGENT): 132783 ms
Total Talk Time (CUSTOMER): 163718 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/f37857f4-96fd-4230-94eb-3de7775356b5_20250221T21:51_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good mor well, it is not morning. Good afternoon. I was just needing to get
[AGENT][POSITIVE] Good afternoon.
[CUSTOMER][NEUTRAL] I would just need to get a little bit more information on a denied claim.
[AGENT][NEUTRAL] OK, I can give you the remarks on a denied claim. Can I please get your name and your callback number?
[CUSTOMER][NEUTRAL] Yes, my first name is [PII].
[CUSTOMER][NEUTRAL] Callback number is [PII].
[AGENT][NEUTRAL] OK, and [PII], what is the name of the, the patient's name, date of birth, and the policy number, please?
[CUSTOMER][NEUTRAL] OK. So the first name is [PII], so [PII] I have last name is [PII]
[CUSTOMER][NEUTRAL] I have birthday at [PII].
[CUSTOMER][NEUTRAL] And the claim number, I mean, not the claim number, the member ID is 01792.
[CUSTOMER][NEUTRAL] 144.
[AGENT][NEUTRAL] OK let me pull in that uh policy real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK and then what is the claim number that you're in question about?
[CUSTOMER][NEUTRAL] Yes, so the claim number.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It is 253.
[CUSTOMER][NEUTRAL] 2728.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what's the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Mercy Clinic, Oklahoma Community.
[AGENT][NEUTRAL] OK, this claim number that you gave me, the 253-272-8?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] It's for a completely different member.
[CUSTOMER][NEUTRAL] 252532728
[AGENT][NEUTRAL] Yes ma'am, that's for a different facility and a different member.
[CUSTOMER][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] Our claim numbers usually start with a 3.
[CUSTOMER][NEUTRAL] You say job, OK, let me check because they might have built a wrong insurance.
[CUSTOMER][NEUTRAL] 1 2nd
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And this number took us all the way back to [PII].
[CUSTOMER][NEUTRAL] What did you say? I'm sorry.
[AGENT][NEUTRAL] I said this claim number took us all the way back to [PII].
[CUSTOMER][NEUTRAL] Hm, so do you have that? What is, what is this confusing me.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me look up his policy again, um, [PII], what is the data service?
[CUSTOMER][NEUTRAL] OK, the date of service is [PII].
[AGENT][NEUTRAL] And the charge amount?
[CUSTOMER][NEUTRAL] The charge amount is $79 even.
[AGENT][NEUTRAL] OK, and what is the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So they take the $29 to get adjustment.
[CUSTOMER][NEUTRAL] After their primary insurance pay.
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] Now I'm getting
[AGENT][NEUTRAL] Well, I actually, uh, let's see, let me see on number 4.
[CUSTOMER][NEUTRAL] Cause I, I have the EOB pull up.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Trying to see I'm getting confused.
[AGENT][NEUTRAL] I know where the problem is. I, I just pulled up the claim.
[CUSTOMER][NEUTRAL] OK. Please tell me.
[AGENT][NEUTRAL] OK, I just pulled up the claim. The claim was denied. Let me give you the denial reason why for the $79.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me put that claim number back in there um.
[AGENT][NEUTRAL] OK, claim was denied, office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim number is one digit off. It's 3532728.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] 353-272-83532728.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. I see. And so office visits aren't covered by this plan. OK. And do you spell your name, [PII]?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] [PII], OK, I thought, I don't know why I thought you said something else.
[AGENT][NEUTRAL] No, you spelled, you spelled a good name for [PII], but my mama gave me the boy way.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, it's OK. It's OK. Well, I think, I think that's all I needed. So the, um, so the remaining balance is the patient's responsibility, correct?
[AGENT][NEUTRAL] We actually don't give patient responsibility because that is uh determined by the provider.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Provider, OK, now you can probably hear me. OK then. All right, um, do we have a reference number for the call?
[AGENT][NEUTRAL] Yes, ma'am. You can use my name and today's date.
[CUSTOMER][POSITIVE] OK, alright then. Well, thank you and have a good weekend.
[AGENT][POSITIVE] You too [PII] you have a good weekend also and thanks for calling APL.
[CUSTOMER][NEUTRAL] OK, bye-bye.
[AGENT][NEUTRAL] Bye bye, ma'am.