AccountId: 011433970860
ContactId: 24d1aceb-7bc5-4a78-b2b4-0f6ad87b5bcd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 340079 ms
Total Talk Time (AGENT): 85223 ms
Total Talk Time (CUSTOMER): 116330 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/24d1aceb-7bc5-4a78-b2b4-0f6ad87b5bcd_20250624T16:09_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from Holy Cross Hospital to check on the claim status.
[AGENT][NEUTRAL] I, I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yeah, it's uh [PII].
[CUSTOMER][NEUTRAL] [PII] and extension will be [PII].
[AGENT][NEUTRAL] The policy number of the patient?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, policy number will be 016.
[CUSTOMER][NEUTRAL] 99697 M as in Mike, L as in Lima, number 7.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Yeah. Patient's name is [PII] and date of birth will be [PII].
[AGENT][NEUTRAL] Native service and build charges.
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[CUSTOMER][NEUTRAL] With the amount of $11,476 even.
[CUSTOMER][NEUTRAL] Uh, I did not get your name. Can I, can I have your name?
[AGENT][NEUTRAL] Uh, my name is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And, yeah, uh, [PII], I just want to inform you like I have the information like the claim has been processed and paid for $300 but I'm, uh, there is a remaining balance of $200. I just need to know about that one.
[AGENT][NEUTRAL] OK, let me look up the correct account number. You gave me a terminated policy number, so just a moment.
[CUSTOMER][NEUTRAL] Sure, sure.
[AGENT][NEUTRAL] OK, so that was the max that we'll pay on the policy for the patient's policy?
[AGENT][NEUTRAL] 300 is the maximum.
[CUSTOMER][NEUTRAL] Max amount?
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Uh, is there any patient responsibility over there?
[AGENT][NEUTRAL] This is a secondary supplemental policy, so we can't instruct or determine patient responsibility.
[CUSTOMER][NEUTRAL] OK. Yeah, just a second. Let me have a look here.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh, [PII], do you have the primary UB, uh, with you?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, uh, you can see that, uh.
[CUSTOMER][NEUTRAL] Uh, Blue Cross has, uh, crossed over the $500 to secondary for the payments. But, uh, overall this, we have got only $300 as a payment. Uh, is it remaining going to be some uh co-pay, coinsurance, something like that?
[AGENT][NEUTRAL] All, all we can do is process the claim according to the policy. So for this policy, this benefit pays a maximum of $300.
[AGENT][NEUTRAL] After primary process of the claim. So,
[AGENT][NEUTRAL] You can't instruct on patients.
[CUSTOMER][NEGATIVE] Uh, there's no chance of, uh, getting, yeah, uh, there is no chance of getting the $200.
[AGENT][NEUTRAL] Right, we've paid the maximum of 300, that's the max that the plan will pay.
[CUSTOMER][NEUTRAL] Plan bed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, can we build the, the remaining balance to the patient here?
[AGENT][NEUTRAL] We can't determine patient responsibility or instruct on patient responsibility. It's a secondary supplemental policy, so I can't tell you to bill anyone. I, we can't do that.
[CUSTOMER][NEUTRAL] Uh, can you provide me the claim number?
[AGENT][NEUTRAL] My number 360-466-0.
[CUSTOMER][NEUTRAL] OK. Uh, can you give me the receipt date and the procedure for this claim?
[AGENT][NEUTRAL] I received on [PII], process 52225.
[CUSTOMER][NEUTRAL] Uh, the check has been cashed?
[AGENT][NEUTRAL] Um, let me check.
[AGENT][POSITIVE] Uh, no, it's still outstanding.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] You need the address it was sent to?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah, I have the address as [PII]. That's the correct address, right? Where the check has been issued.
[AGENT][NEUTRAL] No, it's [PII].
[CUSTOMER][NEUTRAL] Just give me a second. Let me look.
[CUSTOMER][NEUTRAL] Uh, you told [PII], right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] Uh, can you provide me your call reference number?
[AGENT][NEUTRAL] My name is [PII], and today's date.
[CUSTOMER][POSITIVE] Oh, thank you, [PII], for your valuable information. Have a great day.
[AGENT][POSITIVE] Thanks for calling APL. You too. Bye-bye.