AccountId: 011433970860
ContactId: 0b30a166-8749-44a9-9356-85e9d682fbef
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 325350 ms
Total Talk Time (AGENT): 86192 ms
Total Talk Time (CUSTOMER): 206767 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/0b30a166-8749-44a9-9356-85e9d682fbef_20250305T14:33_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEGATIVE] Yes, I wanted to ask about a claim that was processed. Um, it's a, a denial. Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I can verify the claim status for you and your name is?
[CUSTOMER][NEUTRAL] Uh [PII]
[CUSTOMER][NEUTRAL] And did you say [PII]? Did I hear that right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK, thank you. OK, thank you.
[AGENT][NEUTRAL] You're welcome. And Ms. [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] Uh, policy number is 02444782.
[AGENT][POSITIVE] OK, thank you one moment.
[AGENT][NEUTRAL] And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] The patient is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, and Miss [PII], do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, and what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] Uh, date of service was [PII], charge amount, $2,326.63.
[AGENT][POSITIVE] OK, thank you. Give me one moment.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and you're calling from?
[CUSTOMER][NEUTRAL] Uh, Martha Jefferson Hospital. It might say Centerra Martha [PII].
[CUSTOMER][NEUTRAL] But it's Martha Jefferson Hospital.
[AGENT][NEUTRAL] OK. And it looks like the claim process says the outpatient benefits of maxed for the calendar year.
[CUSTOMER][POSITIVE] OK. So outpatient benefit.
[CUSTOMER][NEUTRAL] And I, let me see, um, max for the year.
[CUSTOMER][NEUTRAL] I guess my question because the ELB is not like really specific. I didn't know if it's all of this is going to be the patient's responsibility because it doesn't say that on the EOB. So it's all, is this a certain amount of patient's responsibility or is the whole amount of patient's responsibility?
[AGENT][NEGATIVE] Well, we don't give patient responsibility and our EOBs wouldn't reflect that. It would just state how the claim was processed, uh, for this one like the benefits of Max, it doesn't give patient responsibility.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Oh, so if I don't see it as patient responsibility, I'm assuming that doesn't, I mean, cause I, it, I don't, I don't know if I should adjust the whole amount off or.
[CUSTOMER][NEUTRAL] You know, you know what I'm saying, leaves a provider like, um, that's why I called because I don't want to send it to the patient if it's not hers, but some, some, uh, ELBs when it's out of Max, it is the patient's responsibility. So, where do I what do I, what do I do with this? [PII]? I mean, in all honesty.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Well, like I said, we don't give it. Uh, patient responsibility is not something that was free price, it's just.
[AGENT][NEUTRAL] It's just uh the claim process and it's in um.
[AGENT][NEUTRAL] As benefits of Max, so I'm not sure how your office will handle that, but we can't give patient responsibility.
[CUSTOMER][NEUTRAL] OK. They don't give patient responsibility. Ah, that's a tough one. OK. Uh, OK, [PII], do you, do you give a call reference numbers? I have no, I've never heard of such as long as I've been in billing. I, it doesn't. I, and I know it's not your fault, but it just doesn't make sense. You, you know what I'm saying? So,
[AGENT][NEUTRAL] No, I hear you.
[AGENT][NEUTRAL] But uh you may use my name in today's date is reference if you like.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, thank you. This, so I'm sorry, was, was it given a claim number or no?
[AGENT][NEUTRAL] 3,549,590. It should be on the EOB, but it's um
[CUSTOMER][NEUTRAL] Because I don't see one on the EOB.
[CUSTOMER][NEUTRAL] Uh, I, I was looking for that.
[CUSTOMER][NEUTRAL] Because they have the, let me see, they have the policy number. Oh, OK. No, then I don't see that on the LB because I looked over thoroughly, I don't see that on there. So, um, I don't know. I'll just have to see.
[AGENT][NEUTRAL] It should be at the top of the EOB where it shows the policy number.
[AGENT][NEUTRAL] And the total charge amount.
[CUSTOMER][NEUTRAL] Let me see, I see
[CUSTOMER][NEUTRAL] Uh, oh, OK, it does say, OK, here's the claim number. It does say over here to the left. OK, I missed that. I was too busy trying to see if it was patient responsibility because I did see, I did notice they say outpatient benefits for this calendar year, and I know that mean it maxed out, but I was looking for patient responsibility. It makes sense. I said, well, let me call and make sure before I send it to the patient.
[CUSTOMER][NEUTRAL] So I'll just check with um how they do it on this end, because this can't have been the first claim that they have this uh from uh APL. So I'll just have to ask someone about it. Do we just send it to the patient? OK, thank you. Have a good day.
[AGENT][POSITIVE] Alright, you're welcome. You too. Bye.
[CUSTOMER][NEUTRAL] Uh, uh, bye, bye.