AccountId: 011433970860
ContactId: f4467a33-c322-4235-81a6-733b4afae05e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 927789 ms
Total Talk Time (AGENT): 300437 ms
Total Talk Time (CUSTOMER): 267722 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/f4467a33-c322-4235-81a6-733b4afae05e_20250212T14:34_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good morning. This is [PII] calling from the provider office to check on the general claim status.
[AGENT][NEUTRAL] OK, sure. I can assist you with claim status, Mr. [PII] and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure. Uh, the callback number is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Sure. I'm calling from the Mount Carmel Medical Group.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And may I have the policy number of the patient, Mr. [PII]?
[CUSTOMER][NEUTRAL] Sure. The policy number is
[CUSTOMER][NEUTRAL] 02539166
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Sure. The, the member's first name is [PII] and the last name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is uh [PII], [PII].
[AGENT][NEUTRAL] OK, and what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Sure. The date of service is uh [PII] with the bill amount of $926 even.
[AGENT][NEUTRAL] OK. Thank you. Let me see if I can find this claim for you. [PII] for 926. Is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And for future you can check claim status online through our website at [PII] and that's gonna be optional and bear with me. I'm searching for your claim.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Uh, I have tried to log in into the portal, but I have, I am facing the difficulty that I have entered the tax ID and that the patient account number which I have entered, it is not uh taking.
[AGENT][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] And it is showing that to if there is an uh error, please contact the service customer.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, it's fine. Yeah, and the patient's account number is gonna be the, the number that is indicated on box 26, um, which is the, yeah.
[CUSTOMER][NEUTRAL] Yeah, uh.
[CUSTOMER][NEUTRAL] Yeah, I have
[CUSTOMER][NEUTRAL] Yeah, I have tried with the, the ID number and uh uh as well as patient account number.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] But uh it was not taking.
[AGENT][NEUTRAL] It's fine.
[CUSTOMER][NEGATIVE] Yeah, no, no user was found with the information that was entered. Please try again. If this error persists, please contact the customer service. They are, uh, the message is popping up.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there any, uh, another way to register the portal?
[AGENT][NEUTRAL] No, when I'm done with the claim, we can go through that portal.
[CUSTOMER][NEUTRAL] Yeah. OK. OK. OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it looks like we have uh processed and received the claim. Um, let me check and see when we received the claim. One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, we received this claim [PII], processed [PII].
[CUSTOMER][NEUTRAL] Uh-huh. May I know the claim number, please?
[AGENT][NEUTRAL] And the
[AGENT][NEUTRAL] Yes, the claim number is 351-7925. Again, that's 3517925.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, the claim was denied. The reason is that the policy does not provide wellness benefits.
[AGENT][NEUTRAL] Or immunization or vaccines.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] May I know the denied date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And they denied as a non-covered charges.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Under the patient planner, provider plan?
[AGENT][NEUTRAL] Under the patient's plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Is there any explanation of benefits for this claim?
[AGENT][NEUTRAL] Yes, we do have an explanation of benefits, um, and that's under that claim number 351-7925. Um, let me.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Uh, can
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, if you fax it, it will be helpful to you, ma.
[AGENT][NEUTRAL] OK, what is the fax number?
[CUSTOMER][NEUTRAL] Sure. The fax number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And I'm repeating again, [PII].
[AGENT][NEUTRAL] OK, so what.
[CUSTOMER][NEUTRAL] Attention to [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Attention to [PII].
[AGENT][NEUTRAL] How do you spell it?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. Thank you, Mr. [PII]. And let's see.
[AGENT][NEUTRAL] Do you want to go ahead and fix the website um information? OK.
[CUSTOMER][POSITIVE] Yeah, yeah, I'm ready. Before that, may I know your name?
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] OK, before, uh call reference number be?
[AGENT][NEUTRAL] We don't have reference numbers you can use my name to the date.
[CUSTOMER][NEUTRAL] Yeah. OK, sir.
[CUSTOMER][NEUTRAL] Uh, can we go with the portal?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, mhm. So if you're in our portal, um, you go to the um [PII], you're gonna click on new user and you're gonna go ahead and click on a medical dental provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, next.
[CUSTOMER][NEUTRAL] So it is showing tax ID.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I'm entering my tax ID.
[AGENT][NEUTRAL] OK, and you're using the tax ID? OK. And then what's the patient's account number that you're using?
[CUSTOMER][NEUTRAL] Yeah, I have entered my tax ID.
[CUSTOMER][NEUTRAL] Uh, the [PII] [PII] [PII]. This is the patient account number, so I'm entering it.
[AGENT][NEUTRAL] OK, the patient's account number, let me check and see if it looks like it's a little bit different, one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so it's missing an 8. So, the patient's account number we have here.
[AGENT][NEUTRAL] Is P for [PII] 139,827,500.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK. It is missing. I think, uh, can I, can I check it once again, [PII] 139,827,500.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah. Uh-huh, it's OK.
[AGENT][NEUTRAL] OK, right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, so I'm gonna send this one. You can go ahead and print the rest um once you register, OK, but I can go ahead and I'm gonna go ahead and send this one out, OK? So let me go ahead and take care of that. I'm gonna put you on a brief hold so I can go ahead and send it right now, OK? One moment.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][POSITIVE] Thank you for holding and being patient for me, Mr. [PII]. OK, I went ahead and send that one out to you. It should be there in a few minutes. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Uh, so, uh, for the information, uh, the claim has been, uh, been denied as non-covered, uh, charges under the patient plan. Uh, what are the, uh, uh, what is the plan?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, this is a limited hospital indemnity plan.
[CUSTOMER][NEUTRAL] Limited hospital entity plan?
[AGENT][NEUTRAL] Limited hospital indemnity plan.
[CUSTOMER][NEUTRAL] Hospital. Uh, could you please spell the word, that?
[AGENT][NEUTRAL] The indemnity
[CUSTOMER][NEUTRAL] After hospital?
[CUSTOMER][NEUTRAL] Uh, could you please spell it?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, I can spell it. One moment.
[AGENT][NEUTRAL] OK, so that's [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I for India, N for Nancy, D for Delta, E for Echo, [PII]. Is it correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. So, thank you. But I have registered the portal, but it is showing the same.
[AGENT][NEUTRAL] Mm, it's probably not taking the password. If the password is really in depth. It has to be um a cap, small letters. It needs to have a special character. So, yeah, usually.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, I, I have, yes, I have added the uh special characters. I have added the two special characters, one capital letter, and the three numbers.
[AGENT][NEUTRAL] You use one special character or two special characters?
[CUSTOMER][NEUTRAL] 11 special character.
[AGENT][NEUTRAL] Mm, OK.
[AGENT][NEUTRAL] Yeah, I'm not sure why it's not working, but um um
[AGENT][NEUTRAL] And you have to.
[CUSTOMER][NEUTRAL] Yeah, it is showing looks like where.
[CUSTOMER][NEUTRAL] It is popping up the message like uh looks, we are experiencing the technical difficulties.
[AGENT][NEUTRAL] More than likely it's because it's not taking one of the information. You have to check the red marks and see uh why it's not there, you know, mhm, yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, OK, OK.
[CUSTOMER][POSITIVE] OK. Thank you. OK. OK, sir. Thank you. Thank you for assisting the claim. Have a good day and take care. Bye-bye.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yes. Is there anything else I can help you with today, Mr. [PII]?
[CUSTOMER][NEUTRAL] No, how many days, uh, can I get the EOB?
[AGENT][NEUTRAL] Oh, it should be there in a few minutes. If you don't get it within 15 minutes, you can give us a call back and we can resend it, but it should be there shortly.
[CUSTOMER][POSITIVE] OK. OK. So, thank you.
[AGENT][NEUTRAL] Electronically. Mhm.
[AGENT][POSITIVE] You're welcome. Have a good day, Mr. [PII]. Bye-bye.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][POSITIVE] You're welcome.