AccountId: 011433970860
ContactId: fea93ee7-3789-4f39-83c8-d5d33329818f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 409000 ms
Total Talk Time (AGENT): 128277 ms
Total Talk Time (CUSTOMER): 200099 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/fea93ee7-3789-4f39-83c8-d5d33329818f_20250318T13:04_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] with uh Bluegrass Community Hospital calling to check on a couple claims.
[AGENT][NEUTRAL] OK, well, I can definitely help you with your claims, [PII], and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah my direct line is [PII].
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Uh, just 2.
[AGENT][NEUTRAL] OK, is it the same number?
[CUSTOMER][NEUTRAL] Same number 22 different data service.
[AGENT][NEUTRAL] OK. Um, may I have the policy number?
[CUSTOMER][NEUTRAL] Yeah, member ID I have is 259-053-9.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And [PII], may I have the dates of service and the total bill?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, the first one, the data service is $1121.24 total charge is $9,496.01.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And one sec, OK, here it is. Hold on one moment.
[CUSTOMER][NEUTRAL] OK, right, 01 at the end.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yeah, Bluegrass Community Hospital.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You need an NPI or tax ID?
[AGENT][NEUTRAL] No, no, it's OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 417.
[AGENT][NEUTRAL] Here it is.
[AGENT][NEUTRAL] Alright, so I'm showing we received the claim on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim number is 3563107.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Let me see why.
[AGENT][NEUTRAL] Outpatient treatment due to sickness is not covered on this policy. Um, it's in, it's due to accident only. Um, if you have additional information that indicates an accident, please submit for further review.
[CUSTOMER][NEUTRAL] Alright, uh, covers outpatient accidents.
[CUSTOMER][NEUTRAL] Only.
[CUSTOMER][NEUTRAL] Um, so for outpatient treatment due to sickness, um, not covered.
[CUSTOMER][NEUTRAL] Covers outpatient accident only um let me see I don't think I have.
[CUSTOMER][NEUTRAL] An EOB response on this yet because it was so recent um let me see, maybe I do.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I can, I can fax you a copy if you need it.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Actually I think I've got it here. Um, outpatient treatment due to a sickness is not covered under this policy. The additional information that indicates an accident, please submit for further review, uh, refer to section 5 benefits outpatient accident treatment benefit, OK.
[AGENT][NEUTRAL] You do? OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, well, it's right there, um, let me go ahead and I'll notate that that's in there and reach out to the patient. I have a feeling we'll probably be reaching out to both, um, but reach out to the patient, let them know this is a non-coverage service for their policy, um, so there's no coverage for it. So do they have any other insurance, um, so I'll give them a call and find out. Do you give a reference number per call or per claim?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, per call, so the reference number for the entire call is going to be my name and today's date. Um, the first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, no problem.
[CUSTOMER][NEUTRAL] OK, you got it. Put that in there.
[CUSTOMER][NEUTRAL] [PII] and then.
[CUSTOMER][NEUTRAL] I'll put the call reference here for the first one call reference number, uh, [PII] and 0318-2025.
[CUSTOMER][NEGATIVE] Alright, second one since that's clearly not covered.
[CUSTOMER][NEUTRAL] Um, situation, second one, same hospital, same patient, um, but the data service is 11 1924.
[AGENT][NEUTRAL] 1119.
[CUSTOMER][NEUTRAL] And a different total charge whenever you're ready for it.
[AGENT][NEUTRAL] OK, and what's the total?
[CUSTOMER][NEUTRAL] Uh, total charge on that one is $8,221.90.
[AGENT][NEUTRAL] OK, and I just found that one. Hold on one moment.
[AGENT][NEUTRAL] Alright, so this claim was received on [PII]?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 357-583-2.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied um for the same reason, the policy doesn't cover uh outpatient sickness.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Outpatient treatment is not covered.
[CUSTOMER][NEUTRAL] Covers accidents only.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, so I'll reach out to the patient about both of these, um.
[CUSTOMER][NEGATIVE] And see about getting uh any kind of other information from them um regarding insurance otherwise say if they've got no coverage, guess what? That's no coverage.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Unfortunately.
[AGENT][NEUTRAL] That's true, right.
[AGENT][NEGATIVE] I wish it was better news.
[CUSTOMER][POSITIVE] I mean nothing, nothing you can really do about it so but that's all right we'll we'll reach out to the patients and see what they got. So thank you, [PII], for all your help this morning.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] That'll be it you have a great day.
[AGENT][POSITIVE] Thank you, you too. Thanks for calling APL.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Yep bye bye.