AccountId: 011433970860
ContactId: 0f91c8aa-75b9-4e96-bdb9-24bd4b692b5c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 294890 ms
Total Talk Time (AGENT): 139520 ms
Total Talk Time (CUSTOMER): 146456 ms
Interruptions: 9
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/0f91c8aa-75b9-4e96-bdb9-24bd4b692b5c_20250217T13:25_UTC.wav
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[AGENT][POSITIVE] Thanks for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hiya, my name is [PII] from provider office. Uh, I have some questions regarding the claims.
[AGENT][NEUTRAL] Sure, I can assist you with that. Could you provide me with the spelling of your name and a callback number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, that is [PII] and the callback number [PII] direct line.
[AGENT][NEUTRAL] And what is the policy number of the member that you're inquiring claim status for today?
[CUSTOMER][NEUTRAL] Uh, that would be 01823349 and [PII] [PII] [PII] number 8.
[AGENT][NEUTRAL] Thank you, [PII] and you're calling to verify claim status. Could you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And what is the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is your bill amount?
[CUSTOMER][NEUTRAL] And the
[CUSTOMER][NEUTRAL] Uh, it will be $44,426.11.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] 6
[AGENT][NEUTRAL] For facility charge?
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] The claim was submitted here to American Public Life [PII]. It was processed [PII]. There was a payment of $500 made on this claim.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The of.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes, uh, actually we do receive that $500 even. However, the primary leftover amount as a patient responsibility, that would be $3,786.54.
[AGENT][NEUTRAL] Got you. Per the policy, [PII], the member's benefit is only $500 per calendar day. So once that $500 per calendar day is exhausted, then those are the the ben there's no longer any benefits available for that date of service.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the uh so the remaining balance can be billed to the patient?
[AGENT][NEUTRAL] So due to us not being a primary insurance company, I can't I can't tell you that information. The only thing that I can provide you with is that we made a payment of $500 which are benefits per calendar day were maxed out and.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] That's all the APL will pay on it is the $500 due to us not being a primary insurance company. I can't say if it's the patient responsibility or not, however, I do know that we only pay $500 of the balance that was remaining for the patient responsibility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And the uh for the policy, uh, the only $500 can be paid for calendar day. Is it under the patient's plan or what plan is that?
[AGENT][NEUTRAL] It's under the patient's plan. The patient's outpatient benefits is $500 per calendar day, and this is not a guarantee of benefits, just a disclaimer of the policy's coverage coverage. And once that $500 has been capped out, then there's no available benefits for that day.
[CUSTOMER][NEUTRAL] today.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] that $500 has been kept out.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, thank you so much and uh for my reference, can you please provide me uh what would be the timely filing for an appeal and the appeal address?
[AGENT][NEUTRAL] There's no timely filing and the appeal address will be the same as the claims address which is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 248,950
[CUSTOMER][NEUTRAL] To.
[AGENT][NEUTRAL] Ok [PII].
[CUSTOMER][NEUTRAL] 24.
[CUSTOMER][NEUTRAL] 248.
[AGENT][NEUTRAL] That's 248,950 PO Box 248,950.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much and uh uh what
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, thank you so much. Uh, what would be the call reference number?
[AGENT][NEUTRAL] There's no reference number, Burling. Unfortunately you can use my name in today's date as a reference. My name is [PII] and today's date.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] OK, thank you so much for your information, so that, that's all I have for now. Have a wonderful day. Bye bye.
[AGENT][POSITIVE] Thanks for calling APL. You have a great one as well. Goodbye.