AccountId: 011433970860
ContactId: fc164165-f87c-4c76-8487-4e9c0406b521
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 285179 ms
Total Talk Time (AGENT): 89561 ms
Total Talk Time (CUSTOMER): 119606 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/fc164165-f87c-4c76-8487-4e9c0406b521_20250108T16:39_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh hi, [PII]. My name is [PII] calling you from Mercy Hospital, calling you information on a claim.
[AGENT][NEUTRAL] OK, so you calling in regards to claim status?
[CUSTOMER][POSITIVE] Yes, that is correct.
[AGENT][NEUTRAL] OK, I can help you with that. And may I have the spelling of your name, please?
[CUSTOMER][NEUTRAL] Sure. My name is [PII]. That's spelled [PII].
[AGENT][NEUTRAL] Thank you. And so, in case this call is disconnected, may I have your callback number?
[CUSTOMER][NEUTRAL] Oh well.
[CUSTOMER][NEUTRAL] Sure. My callback number [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yes. Their policy number under 1359342.
[AGENT][NEUTRAL] Thank you, and it was 1359342?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] And may I have the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you. And may I have the date of service and the bill amount?
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] [PII], that amount, $4,651.18.
[AGENT][NEUTRAL] Thank you. So that's for a data service of [PII] for $4,657.18.
[CUSTOMER][NEUTRAL] Of $4,651.18. Yes.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] So, we did receive that claim on [PII] and it was processed on [PII]. Nothing was paid on this particular claim because services were rendered after the coverage had terminated. I showed the, the plan termed.
[AGENT][NEUTRAL] 121 of 2021 and I don't show any active coverage.
[AGENT][NEUTRAL] At this time.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Would you like the claim number?
[CUSTOMER][NEUTRAL] 121 of 2021. Uh I have it. I have the claim number in here. We've received it as 3529691, isn't it?
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] Yeah, but that, you know, that EOB doesn't say if the claim is denied for that reason. And there is, there is an incomplete information was received. Uh, one moment, [PII]. I have to check the patient for the visit.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Bear with me, please. Yeah.
[CUSTOMER][NEGATIVE] Go down accounts.
[CUSTOMER][NEUTRAL] Mm 1110 24.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] There was nothing.
[CUSTOMER][NEUTRAL] From IPL.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, [PII], not a problem. And um
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Uh, as we've received an incorrect TOB, could you please make the correct TOP that shows the claim is denied as coverage and, um, services rendered off to the coverage terminated.
[AGENT][NEUTRAL] That was what's listed on the EOB that we have, that is what was listed on the initial EOB. I can send you a copy of that EOB again or we can mail it or fax it to you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] Yeah, I'll give a fax number, secured fax number.
[AGENT][NEUTRAL] OK, and what is that fax?
[CUSTOMER][NEUTRAL] 678
[CUSTOMER][NEUTRAL] 306-473-0.
[AGENT][NEUTRAL] Thank you, and that was [PII]?
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] And do I just need to make it to your attention?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][POSITIVE] OK, I will get that faxed over to you. Is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Uh, that's all right today. [PII], thank you so much. What's the call reference number?
[AGENT][NEUTRAL] It'll be just my name in today's date, and that's [PII]
[CUSTOMER][NEUTRAL] Yes my name
[CUSTOMER][NEUTRAL] Yeah, last initial?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, [PII]. Thank you. Bye-bye. Take care.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. You have a good day as well. Bye.
[CUSTOMER][NEUTRAL] Yeah.