AccountId: 011433970860
ContactId: 0e1ba132-56da-4829-a8b3-b7461e499027
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 352130 ms
Total Talk Time (AGENT): 129553 ms
Total Talk Time (CUSTOMER): 155143 ms
Interruptions: 3
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/0e1ba132-56da-4829-a8b3-b7461e499027_20250303T20:03_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] from Holy Cross Hospital. This call is regarding the claims payment.
[AGENT][NEUTRAL] May I please have a callback number?
[CUSTOMER][NEUTRAL] [PII] direct line and can you please spell your name for me?
[AGENT][NEUTRAL] It is spelled [PII] last initial of [PII] and today's date will be the call reference.
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] You're welcome, and may I please have the policy number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes. Uh, I have the policy ID number. That would be.
[CUSTOMER][NEUTRAL] 01988259 E Mary L Lima number 8.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], there about [PII].
[AGENT][NEUTRAL] And you're calling in regards to a status of a claim. May I please have the date of service and total bill?
[CUSTOMER][NEUTRAL] Uh, it's [PII] with the bill amount $6460.90.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And you can also check claim status via our secured portal that is [PII] and I'm pulling that information up for you now.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And I did pull that claim up for you.
[AGENT][NEUTRAL] And it does show that we did receive that claim and process and made a payment. The receipt on that claim is [PII].
[AGENT][NEUTRAL] The payment date was [PII].
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Uh, actually, yeah, actually, we do receive a payment for $437.56 and with no patient responsibility. Uh, however, when we contact, however, if I see the uh primary EOP, I found that, you know, the patient responsibility left over by the primary insurance as a deductible and the co-insurance. That would be $2,988.27.
[CUSTOMER][NEUTRAL] So we have 5 the primary. You will be back on [PII].
[AGENT][NEUTRAL] OK, so due to the payment of the claim that I was advising of which was paid on [PII], it also states that once the 437566 was paid, that was the per calendar day max that could be paid out on that claim.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh uh is there any denial on this claim or is it like the maximum amount that can be paid per day it's already that for 137?
[AGENT][NEUTRAL] As I stated, once the 43756 was paid, that is the per calendar day max.
[CUSTOMER][NEUTRAL] And.
[AGENT][NEUTRAL] That could be paid on that claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, no worries, uh.
[CUSTOMER][NEUTRAL] Can, uh, for my reference, can you please provide me what would be the timely filing for submitting an appeal? And by the way, uh, before submit, uh, providing me that one, is it under the patient plan and can we bill the remaining balance to the patient?
[AGENT][NEUTRAL] That is to provide a description if you, if they would like to submit that bill to the patient.
[AGENT][NEUTRAL] But as of right now, the member has no other available balance that could be paid out for that date of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so the remaining balance that should go as a provider write off or a patient responsibility?
[AGENT][NEUTRAL] That's the provider's choice. I can't tell the provider how to bill.
[CUSTOMER][NEUTRAL] OK. Thank you so much and uh if we need to submit any appeals to the uh payer, what will be the time, uh, timely filing and the address?
[AGENT][NEUTRAL] We have no timely filing and you will submit it either via fax or the mailing address as the submission of the claim. Do you need that mailing address again?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, please provide me the fax number instead.
[AGENT][NEUTRAL] The fax number is [PII].
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] and it does look like we have received that claim in several times and those claims were re-reviewed and denied as a duplicate of the previous submitted claim.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and is there any call reference number?
[AGENT][NEUTRAL] As I stated at the beginning of the call, it is my first name, last initial, and today's date.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][POSITIVE] OK, thank you so much for your information. Uh, that's all I have for now. Have a wonderful day. Bye bye.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life. Have a great day.
[CUSTOMER][NEUTRAL] Yeah