AccountId: 011433970860
ContactId: 1ea52af7-26c2-45f8-a734-1949c6e1e8d0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 352600 ms
Total Talk Time (AGENT): 144152 ms
Total Talk Time (CUSTOMER): 147483 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/1ea52af7-26c2-45f8-a734-1949c6e1e8d0_20250221T21:10_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Oh hi, this is [PII]. I'm calling from the provider's office regarding a claim for a patient and you said your name is?
[AGENT][NEUTRAL] Uh, my name is [PII], last initial [PII], and you say your name is [PII]?
[CUSTOMER][NEUTRAL] Yes, it's [PII] initial to my last name is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what is that policy number, please?
[CUSTOMER][NEUTRAL] OK, just a moment. Uh, the policy number is 02478746 Mike Charlie 7.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Mm, yes, it's [PII].
[AGENT][NEUTRAL] OK, and verify the patient's name, date of birth, please.
[CUSTOMER][NEUTRAL] OK. The patient's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And you say you're calling to verify claim status, is that correct?
[CUSTOMER][NEUTRAL] Oh, no, uh, to us, so to be precise, I'm calling in regards to check, uh, a fax that was sent on [PII], uh, as the claim was denied requesting the primary UB.
[AGENT][NEUTRAL] Uh, what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] Um, the date of services.
[CUSTOMER][NEUTRAL] Mm, that's [PII]. And the total charges are $14,063 even.
[AGENT][NEUTRAL] OK, thank you. And do you have the balance after primary Insurance has processed the claim?
[CUSTOMER][NEUTRAL] Mm, yes, uh, that's uh 500.
[AGENT][NEUTRAL] OK, bear with me one moment.
[CUSTOMER][NEUTRAL] Just a moment, that's $500. Just let me confirm that once. Yes, the patient responsibility was $500 which was the uh co-payment or co-insurance to be set.
[AGENT][NEUTRAL] OK, one moment. And while I'm looking up claim information, let you know we do have an online service center where providers can check claim status as well as print out the EOB. That site is at [PII]. And what's the name of the provider's office?
[CUSTOMER][NEUTRAL] OK, just a moment. I was just noting down the site. It's [PII], right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] [PII]. All right, thank you so much. And yes, the provider's offices. OK, it's at CAFL University Hospital.
[AGENT][POSITIVE] OK, thank you. Give me one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I show the claim paid $300 and with that payment, it matched their benefit for the data service.
[CUSTOMER][NEUTRAL] OK, paid $300. OK, and OK, so the rest of the $200 was not paid because it, uh, match the benefit for that particular date of service.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so the rest of the $200 would that be the patients responsibility?
[AGENT][NEUTRAL] Uh, we can't give patient responsibility. We can only verify how the claim was processed, which paid 300.
[CUSTOMER][NEUTRAL] OK. And could you please help me out with the details of the claim?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, claim number 356-589-1.
[AGENT][NEUTRAL] Processed on [PII].
[AGENT][NEUTRAL] And a single paper check was sent out on or I'm sorry, was issued on the [PII] and it was mailed out on the [PII], which was yesterday.
[CUSTOMER][NEUTRAL] Mail on [PII]. Alright, just a moment, mm, [PII]. OK.
[CUSTOMER][NEUTRAL] OK. And uh could you please uh verify the address it was mailed to?
[AGENT][NEUTRAL] Sure. It was mailed to [PII].
[CUSTOMER][NEUTRAL] Uh, I'm so sorry about that, but could you please repeat that again, um, uh, a bit slowly.
[AGENT][NEUTRAL] Sure. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII]. Alright, thank you so much and so um could you please, uh, fax the COB to us I mean.
[AGENT][NEUTRAL] As I stated, we do have that online service center. If you go on to the site, put in a tax ID number and a patient account number, you'll be able to set up a username and password, and they do have a quick feature feature where you can put in a claim number and pull up the EOB.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, alright, uh, perfect, no worries, thank you so much for that. And yeah, that's all I wanted to know for this patient and.
[CUSTOMER][NEUTRAL] Mm, could you please help me out with the call reference number?
[AGENT][NEUTRAL] Uh, we don't give reference numbers. If you like, you may use my name in today's date, and again it's [PII].
[CUSTOMER][POSITIVE] OK, all right, thank you so much and I hope you have a wonderful rest of your day.
[AGENT][POSITIVE] Oh, you too. Thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye.