AccountId: 011433970860
ContactId: 1991a88e-34e3-4e56-a680-34711360fe2d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 907659 ms
Total Talk Time (AGENT): 208002 ms
Total Talk Time (CUSTOMER): 292926 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/1991a88e-34e3-4e56-a680-34711360fe2d_20250424T15:19_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, [PII], my name is [PII]. I'm calling from provider office regarding claim status.
[AGENT][NEUTRAL] OK, I can help you with claim status. And what was your name again? I didn't catch that.
[CUSTOMER][NEUTRAL] Yeah, my name is [PII].
[AGENT][NEUTRAL] OK. Um and do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's um 01846260, M for Mike, L for Lima, and 8.
[AGENT][NEUTRAL] You have a good callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] And the date of service and build them out?
[CUSTOMER][NEUTRAL] The date of service [PII] and the bill amount.
[CUSTOMER][NEUTRAL] $11,348.15.
[AGENT][NEUTRAL] OK, let me get this pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it looks like we received it 12-4-2024, processed on 12-4-2024.
[CUSTOMER][NEUTRAL] Just, uh just hold on. So, actually, sorry for the interruption. So actually I noted everything on a notepad, so could you repeat again slowly? So receive date on, received on [PII].
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Well, [PII].
[CUSTOMER][NEUTRAL] [PII]. What is the process date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, what was the claim status?
[AGENT][NEUTRAL] We made a payment of 46,310.
[CUSTOMER][NEUTRAL] The claim was paid, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] How much do I want?
[AGENT][NEUTRAL] 46,310.
[CUSTOMER][NEUTRAL] $4663.10 right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, um, or is there, is there any patient responsibility co-pay?
[AGENT][NEUTRAL] Um, we don't determine patient responsibility. We're secondary.
[CUSTOMER][NEUTRAL] OK, payment done on uh which date?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, you said the claim paid, right? Claim paid on which date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, 2424 payment done through check or after each one of those two.
[AGENT][NEUTRAL] a check, a single check, check number?
[CUSTOMER][NEUTRAL] OK. Just hold on. So I wanted to.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Sorry for the interruption. So give me a moment.
[CUSTOMER][NEUTRAL] OK, what are the check number?
[AGENT][NEUTRAL] 2016685.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's a single check or bulk check?
[AGENT][NEUTRAL] Single
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, may I'll check the mailing address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, it's correct.
[AGENT][NEUTRAL] You need the cash date?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, uh payment uh is clear or not?
[AGENT][NEUTRAL] Yes, the payment was cash.
[AGENT][NEUTRAL] And cleared [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What is the claim number?
[AGENT][NEUTRAL] 353-676-3
[CUSTOMER][NEUTRAL] That's it.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Is there any payer ID? Your payer ID?
[AGENT][NEUTRAL] Our payer ID is 60801.
[CUSTOMER][NEUTRAL] Could you repeat again? The pay ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So actually, uh, I have a few questions on this, on this one. The primary bill amount is $11,348.15.
[CUSTOMER][NEUTRAL] And the crossword amount to secondary uh $978.50 but secondary paid only $463.10 or the remaining balance is $515.40. Uh, can you explain the remaining balance?
[AGENT][NEUTRAL] Uh, let me see what we probably paid out on a different claim. Let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, let me pull this up. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, the max per calendar day is 500. That's the max we'll pay in one day. It's like there was a little bit of that balance paid on a different plane.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] The remaining balance paid on different claim.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Remaining, could you explain the, what is the claim number?
[AGENT][NEUTRAL] I can't give you information except for what you're asking about.
[CUSTOMER][NEUTRAL] For this one.
[AGENT][NEUTRAL] I can only give you
[CUSTOMER][NEUTRAL] Yeah, you said that the remaining balance.
[AGENT][NEUTRAL] Right, on a different claim for a different provider. I can't give you information about different providers.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, you said that
[CUSTOMER][NEUTRAL] OK what was the provider?
[AGENT][NEUTRAL] I can't give you that information. I can only tell you about the claim you're asking about.
[CUSTOMER][NEUTRAL] Yeah, but it shows uh $500 remaining balance. Can you explain that it showed that the remaining balance is paid to different provider, right? So different insurance company.
[AGENT][NEUTRAL] No, a different provider, a different doctor.
[AGENT][NEUTRAL] Uh insurance company.
[CUSTOMER][NEUTRAL] Your doctor.
[CUSTOMER][NEUTRAL] So it shows $515.40.
[CUSTOMER][NEUTRAL] A patient or register balance.
[AGENT][NEUTRAL] We don't determine patient responsibility since we're secondary.
[CUSTOMER][NEUTRAL] OK, what will we do for this one?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] OK, please let me hold on 2 minutes.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Thanks for being on hold.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'll call transfer to my supervisor. He can handle this call.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yeah. Hi, hi, [PII]. Uh, this is [PII]. You, you can spell my name as, yeah, my email my name can be spelled as [PII], and I am the one of the supervisor who is handling this uh colleagues here.
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] So I had a quick question on this claim that the claim has been processed here and you're stating that uh.
[CUSTOMER][NEUTRAL] The claim has been processed and we have paid with an amount of $463 with 10 cents, but uh the uh
[CUSTOMER][NEUTRAL] But the, but we have to get the amount of $978 with uh 50 cents. So can you give me that uh why the claim, the why the claim has been paid uh.
[CUSTOMER][NEGATIVE] Underpaid and uh
[CUSTOMER][NEUTRAL] How can I get the remaining balance?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] As I explained to [PII], the benefit under this policy is $500 per calendar day.
[AGENT][NEUTRAL] So that's the maximum we will pay per calendar day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And another provider submitted a claim, not your provider, so I can't give you other claim information for different providers. I can only give you the information you're asking about.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So another provider was paid.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The small portion, so 500 is the max we will pay per day. And I also can't tell you what patient responsibility is. We're secondary, you have to determine that yourself. We can't determine patient responsibility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, the remaining balance can be the patient responsibility. So we uh patient is, uh, patient is responsible to get the payment.
[AGENT][NEUTRAL] I can't tell you what to bill to the patient, so I can just tell you how we process this claim.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So can you give me the complete payment details and how we process this claim?
[AGENT][NEUTRAL] We paid
[CUSTOMER][NEUTRAL] What is the allowed amount for this claim then?
[AGENT][NEUTRAL] There's not an allowed amount. This is a secondary policy, so there is no allowed amount. The the policy has a benefit that pays $500 per calendar day, maximum.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] $100 maximum a calendar. They, they are the one.
[CUSTOMER][NEUTRAL] Bay, right?
[AGENT][NEUTRAL] Day, yes.
[CUSTOMER][NEUTRAL] OK, the maximum there. OK. So, so you paid $463 with 10 cents for this, uh, claim and uh remaining balance for another uh another claim, uh, another services or which has been submitted by another provider. So you're stating this, uh this is the payable amount and this is the remaining amount we have paid for this and uh.
[CUSTOMER][NEUTRAL] Yeah. So the remaining balance, how can I get the remaining balance? Is there any chance of getting any remaining, uh, there's the remaining balance of $50 with 40 cents?
[AGENT][NEUTRAL] It won't be from us because if we've paid out the max.
[CUSTOMER][NEUTRAL] Is there no other chances?
[CUSTOMER][NEUTRAL] Uh yeah.
[CUSTOMER][NEUTRAL] OK, so you paid out the maximum.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Yeah.
[CUSTOMER][NEUTRAL] And uh you are seeing that you, you don't provide that uh you're not, uh yeah, so for the remaining balance, I cannot bill the patient also, right?
[AGENT][NEUTRAL] I can't tell you how to bill anything. All I can do as a secondary policy is tell you how the benefit pays and what we paid.
[AGENT][NEUTRAL] I can't give you instructions on what to do after that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, thank you, thank you for providing me this information there. Yeah.
[AGENT][NEUTRAL] I, is there anything else I can help with?
[CUSTOMER][NEUTRAL] Yeah, that's it, nothing. Uh, have a nice day then. Bye-bye. Uh, can you give me the call reference number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The what?
[CUSTOMER][NEUTRAL] Before that, can you give me the call reference number? Call reference number?
[AGENT][NEUTRAL] Oh, it's my call reference number is my name, [PII], and today's date.
[CUSTOMER][NEUTRAL] 99, [PII].
[CUSTOMER][NEUTRAL] Can you spell it?
[AGENT][NEUTRAL] It's [PII] and today's date is the call reference number.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] OK. Thank you. Thank you for providing this information, [PII]. Have a nice day. Bye-bye.
[AGENT][POSITIVE] OK. Thank you. You too. Bye bye.