AccountId: 011433970860
ContactId: 191760b9-3fa5-47cf-ace4-cd693ea36b72
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 402049 ms
Total Talk Time (AGENT): 170337 ms
Total Talk Time (CUSTOMER): 141577 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/191760b9-3fa5-47cf-ace4-cd693ea36b72_20250130T14:49_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]. I was I was calling to get um claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. First name is gonna be [PII] spelled [PII]
[CUSTOMER][NEUTRAL] Contact number is [PII].
[AGENT][NEUTRAL] Thank you for that. And your niece, may I have the member's policy number?
[CUSTOMER][NEUTRAL] Uh, policy is going to be.
[CUSTOMER][NEUTRAL] I have 14529.
[CUSTOMER][NEUTRAL] 63 M like mom, L like Larry, 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh, first name I have is [PII], and it's [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Yes, date of service is uh [PII].
[CUSTOMER][NEUTRAL] I don't know if because um that this is the patient's secondary the total, I guess that you guys um.
[CUSTOMER][NEUTRAL] Uh, $307. I think the claim should.
[CUSTOMER][NEUTRAL] B
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Baptist Health Medical Group Oncology.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Whoa, hold on one second.
[AGENT][NEUTRAL] You said the total may be the $307?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, or the 130 with 99 cents.
[CUSTOMER][NEUTRAL] Because the thing is we send it to her primary insurance and you guys are her secondary, so the remaining balance was $13099 but I guess since we sent the whole claim out to you guys, the total bill amount of that claim is $307.
[AGENT][NEUTRAL] OK, so what's your tax ID?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, the reason I'm hesitating, um, let me go back to that screen. So for for [PII], we have two claims. They're both from [PII]. One of the claims does say $307 but when I put
[AGENT][NEUTRAL] To to see which one is the total bill, so I know which one is which, um.
[AGENT][NEUTRAL] It tells me that the, I got to flip through screens. I'm sorry to get that answer.
[CUSTOMER][NEUTRAL] No, no, it's fine.
[AGENT][NEUTRAL] So it says that the total bill for the claim that I do see $307 on is $4,899.
[AGENT][NEUTRAL] Or there's another claim from [PII], same day, but now that
[AGENT][NEGATIVE] Um, total bills.
[AGENT][NEUTRAL] It's showing $334. I didn't know it's.
[AGENT][NEUTRAL] I don't know what do you think?
[CUSTOMER][NEUTRAL] We haven't, but we only send it.
[AGENT][NEUTRAL] Which one would be yours?
[CUSTOMER][NEUTRAL] We only send it once, like the total bill amount of the whole claim is $307. That's so, and it was for data service the 6-13-2024, and that will never shows you the procedural bill which is 99214.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] All right, hold on one second, 479.
[AGENT][NEUTRAL] OK, so it's this one. I see the tax ID. Alright, so we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 3479799.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Um, stating that the benefits payable under the certificate are limited to those outlined on the schedule of benefits. This is not a covered loss under the plan. Therefore, no amount is payable for this expense.
[CUSTOMER][NEUTRAL] Oh, so you guys wouldn't pay for the deductible because we built, because I guess the we built the primary insurance which is Blue Cross.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh the remaining balance we send it to you guys. So you guys won't cover the deductible amount.
[AGENT][NEUTRAL] So the primary policy, primary insurance has their own benefits and we have our own benefits. So, we work with primary, but whatever was done on that data service is not covered by the policy, so we can't pay out. If it was covered, then yes, we could um pay towards the deductible.
[CUSTOMER][NEUTRAL] Mm, OK, so it wasn't it's not covered.
[CUSTOMER][POSITIVE] OK, no worries. Then it would be then that would fall for the UOB does show you that you'll be is patient responsibility.
[AGENT][NEUTRAL] So on our EOBs, there are, there is no calling for patient responsibility for our medical because we're not the major, so we can't determine patient responsibility.
[CUSTOMER][NEUTRAL] Oh OK, OK.
[CUSTOMER][POSITIVE] OK, I'll go through her primary. OK, perfect. Can I have um.
[CUSTOMER][NEUTRAL] The call reference number please?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name, which is [PII] The first initial to my last name is [PII], and then today's date.
[CUSTOMER][POSITIVE] Perfect thank you so much.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today, [PII]?
[CUSTOMER][POSITIVE] No, that'll be all. Thank you so much.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.