AccountId: 011433970860
ContactId: 0bbdd21b-9f23-4c82-9b4a-1b3716f8a2fb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 712119 ms
Total Talk Time (AGENT): 182876 ms
Total Talk Time (CUSTOMER): 182810 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/0bbdd21b-9f23-4c82-9b4a-1b3716f8a2fb_20250424T16:21_UTC.wav
--------------------------------------------
[CUSTOMER][NEUTRAL] Something, but no, she actually just applied for this too.
[AGENT][POSITIVE] Good morning. Thank you for calling APO. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Hi, this is [PII] from Memorial Hospital in [PII]. I'm checking uh claim status on a medical bill for a patient, please, and I'm sorry, your name again?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome, Miss [PII], and sure, I can assist you with claim status. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Of course, my direct phone number is [PII].
[AGENT][NEUTRAL] Alright, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is that, oh, OK, well that, OK.
[CUSTOMER][NEUTRAL] Is that a certificate number that you're looking for?
[AGENT][NEUTRAL] Yes, mhm, yes.
[CUSTOMER][NEUTRAL] OK, alright, so these are infusion, hm.
[CUSTOMER][NEUTRAL] I don't know if this is outpatient services, but I'm gonna give you 02369683 M like Mary, L as in love, the number 8.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] How patient is this.
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][NEUTRAL] OK, thank you. And what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] It is um [PII]. total charges.
[CUSTOMER][NEUTRAL] $137,818 even.
[AGENT][NEUTRAL] OK. So that's [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, let me see if I can find this claim.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] It's gonna be a minute. Let me pull the EB.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Ms. [PII], for future, you can check claim status online through our website at [PII] and that's just optional.
[CUSTOMER][NEUTRAL] What is it? I, um, yeah, I'm gonna tell you right now, um, secured.
[AGENT][POSITIVE] Secured.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] AM [PII].
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I'll forward this to our um.
[CUSTOMER][NEUTRAL] Department that handles if we are allowed to use your website or not.
[AGENT][POSITIVE] OK, sure, no problem.
[CUSTOMER][NEUTRAL] I could tell you at this point I'm not allowed. Personally, I'm not allowed. I don't know if somebody else has a uh.
[CUSTOMER][NEUTRAL] Access to this.
[AGENT][NEUTRAL] It's OK.
[AGENT][NEUTRAL] It's OK. I understand. All right. Um.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I'm looking at the claim. I see that we process and pay as an outpatient. Um, the reason for that is because um we received the UBO form and it has the date of service only of [PII].
[CUSTOMER][NEUTRAL] Process.
[CUSTOMER][NEUTRAL] OK. Let's see what, um, let me look at the actual claim and see what it looks like.
[AGENT][NEUTRAL] OK, um,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, the services on the UB say [PII].
[AGENT][NEUTRAL] Mhm. Yes, so that's a single day. Um, the explanation of benefits from AMed that we have received, um, it says admission and discharge the same date, and it does have the total charge of $137,818 which they did apply, um, the amount of 6,15459. Now this policy pays only, go ahead.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I, I'm sorry.
[CUSTOMER][NEUTRAL] OK, you said $6,462 which is what the the primary insurance didn't pay, correct?
[AGENT][NEUTRAL] Yeah, that's what they pay and they apply 7,32027 to members responsibility. Now, the policy that the member has with us, um, it has an outpatient daily benefit of $500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Policy
[CUSTOMER][NEUTRAL] Per day only.
[CUSTOMER][NEUTRAL] $500. OK, so my question is if you only pay $500 would the balance be patient responsibility?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so, um,
[AGENT][NEUTRAL] Usually we, we cannot tell you what to do with the claim, but so it's up to the provider's discretion. Most of them, what they do is they go back to the primary EOB and just go by what is applied towards the member's responsibility minus what we paid.
[CUSTOMER][NEUTRAL] OK, and um.
[CUSTOMER][NEUTRAL] Is there no way to get a copy of that EOB?
[AGENT][NEUTRAL] Yes, uh-huh, what is the fax number?
[CUSTOMER][POSITIVE] OK, the fax number is [PII] and if it can come to my attention, [PII], that would be great.
[AGENT][NEUTRAL] OK. [PII]. And you said the last initial is O. So let me go ahead and send this out to you while I got you on the line. Do you mind holding for me?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Sure. No, no, that's perfect. Thank you.
[AGENT][POSITIVE] OK, thank you. All right, thank you. One moment.
[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][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me, Miss [PII]. I went ahead and send that over to you. You should be there in a few minutes. Is there anything else I'm gonna help you with today?
[CUSTOMER][POSITIVE] Yeah, thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, may I have a, let me see where is a note.
[CUSTOMER][NEUTRAL] I need um a reference number, please, if possible, for the phone call.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][POSITIVE] Um, reps name and today's date. OK, well, thank you very much for your time. You have a great day.
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] You're welcome. You're ready as well, Miss [PII] and thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Thank you. All right. Bye-bye.
[AGENT][POSITIVE] You're welcome. Bye-bye.