AccountId: 011433970860
ContactId: 292b961a-59de-46ba-8231-394004c33f3c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1266260 ms
Total Talk Time (AGENT): 222895 ms
Total Talk Time (CUSTOMER): 387375 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/292b961a-59de-46ba-8231-394004c33f3c_20250318T20:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, I'm from the provider's office. I just need to check the status of the claim. Could you please help me regarding this?
[AGENT][NEUTRAL] Yes, I can help you with claim status. Can I please get your name and your callback number?
[CUSTOMER][NEUTRAL] Yes. Uh and my name is [PII]. And I just need to uh like, um, I'm sorry, I have a callback number and my callback number is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then what's the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Uh, actually, I have a claim.
[CUSTOMER][NEUTRAL] Number. Uh, OK. Uh, but I, I was not having the complete EOB. I just need the complete EOB. Could you please help me to send the complete EOB for me?
[AGENT][NEUTRAL] Yes, what is the claim number?
[CUSTOMER][NEUTRAL] Uh, and the number just give me a second.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Just give me a second.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] And the way for this.
[CUSTOMER][POSITIVE] Yes, I got it.
[CUSTOMER][NEUTRAL] Mm, uh, it was 353-676-3.
[AGENT][NEUTRAL] OK, let me see if I can get that pulled up.
[CUSTOMER][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] OK, and then can you please give me your fax number so that I can fax this claim over to you.
[CUSTOMER][NEUTRAL] Uh, OK. Um.
[CUSTOMER][NEUTRAL] Uh, before that,
[CUSTOMER][NEUTRAL] Uh, can you please say, is there any, uh, what, is there any denial reason or anything?
[CUSTOMER][NEUTRAL] here we got a claim like uh we have a claim reason like just give a second.
[CUSTOMER][NEUTRAL] It was paid of 400 and.
[CUSTOMER][NEUTRAL] 400 and
[CUSTOMER][NEUTRAL] Uh, and the remaining balance is $5115.40. Isn't that claim right?
[AGENT][NEUTRAL] OK, let me, um, let me go ahead. We're gonna have to get the insured's policy number, please.
[CUSTOMER][NEUTRAL] And the policy number is.
[CUSTOMER][NEUTRAL] 01846260 M for Mike L for Lima 8.
[AGENT][NEUTRAL] Thank you. And then what is uh the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, the patient's name is [PII], and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And then what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Uh, just give me a second. It's Holy Cross Hospital fort. Holy Cross Hospital.
[AGENT][NEUTRAL] OK. All right, I'm gonna put you on a hold real quick while I finish pulling in the rest of this claim and I will be right back.
[CUSTOMER][NEUTRAL] OK. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, uh, [PII].
[AGENT][NEGATIVE] Looking at the claim, um, it was paid the $463.10. And then after that payment, it exhausted the benefits for that day.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so we have a balance of $515.40 right? So can we adjust this amount?
[AGENT][NEUTRAL] That's not determined by me. That's determined by the provider.
[CUSTOMER][NEUTRAL] Because there was no pay.
[CUSTOMER][NEUTRAL] OK, uh, so, uh, upon checking in the notes, uh, that it was, uh, showing there was no patient responsibility for this, right?
[AGENT][NEUTRAL] We don't give patient responsibility that's determined by the provider.
[CUSTOMER][NEUTRAL] OK, I'm, I'm calling from the provider's office only. I just need to, uh, re verify it once, uh, because here we are not having any info uh, academic codes or any information regarding this. So I just need to, uh, uh, like re verify it once as it was, uh, we have a, uh, like it was, uh, applied towards the providers right now so we can adjust it, uh, right.
[AGENT][NEUTRAL] No, I'm not gonna give that information. That's not for me to determine.
[CUSTOMER][NEUTRAL] OK, so we have to ask the provider regarding this, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, just, just, uh, give me a second. I just, I have some doubt. I will clarify with you one.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Uh, yeah, yeah, I know I got the reason, but uh could you please, uh, send the UOB for us?
[AGENT][NEUTRAL] Yes, I can. What's your fax number?
[CUSTOMER][NEUTRAL] Yeah, and my fax number is [PII].
[CUSTOMER][NEUTRAL] [PII] 2
[AGENT][NEUTRAL] OK, let me repeat it and make sure I've got it correct. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold again while I get that EOB faxed over to you and I'll be right back.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] me.
[AGENT][POSITIVE] Thank you for holding. I've got a copy of that EOB being faxed over to you right now. It's on its way.
[CUSTOMER][NEUTRAL] OK. OK. Could you please uh spell your name for me?
[AGENT][NEUTRAL] Yes, ma'am. It's [PII]
[CUSTOMER][NEUTRAL] Last name insured?
[AGENT][NEUTRAL] A
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, uh, just give me a second.
[CUSTOMER][NEUTRAL] OK, OK, can I get the call reference number for this conversation?
[AGENT][NEUTRAL] Yes ma'am, you can use my name and today's date.
[CUSTOMER][NEUTRAL] OK. Uh, if you don't mind, I have one more account, uh, that was the last account. Could you please help me with that account for me?
[AGENT][NEUTRAL] Yes, ma'am. You can give me the patient's name, date of birth, and policy number.
[CUSTOMER][NEUTRAL] Yeah, and the patient's name is [PII] and the date of birth is [PII]. And the policy number is 02413470 M for Mike, L for Lima 8.
[AGENT][NEUTRAL] OK, let me pull that one up real quick.
[AGENT][NEUTRAL] OK, and can you give me the date of service and the charge amount?
[CUSTOMER][NEUTRAL] And the date of service is [PII] and total charge amount is 5 $5,326.
[AGENT][NEUTRAL] OK, and what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Uh, it was $1,384.76 and you have paid, you have paid, uh, the amount of $290 and there was a balance of $1,0093.79. Uh, yeah, I was not having any, uh, denial reason, so I just need to know, uh, the.
[CUSTOMER][NEUTRAL] Like why the balance, why we have the balance of $1,093.79.
[AGENT][NEUTRAL] OK. And is this also for Holy Cross?
[CUSTOMER][NEUTRAL] Oh yeah, Holy Cross Hospital.
[CUSTOMER][NEUTRAL] Uh, I have, I also have the
[AGENT][NEUTRAL] OK, I'm gonna put you on a.
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] I also have a claim number. Uh, it may help you. It was 352-9313.
[AGENT][NEUTRAL] OK, thank you. I'm gonna put you on a brief hold while I look this up and I will be right back.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi [PII], this is [PII] back with you again. So on this um claim.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEGATIVE] After the amount was paid, it exhausted the benefit for the day.
[CUSTOMER][NEUTRAL] Uh, so what was the benefits?
[AGENT][NEUTRAL] Uh, let me look and see.
[AGENT][NEUTRAL] It maxed out the benefit for the day, it maxed out the payment.
[CUSTOMER][NEUTRAL] OK, um, so can you please.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] Say sorry.
[CUSTOMER][NEUTRAL] So you're saying the maximum benefits was exhausted, right?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, it's only, um, it only goes by $1 amount, so the insured only gets for inpatient, only gets $5000 per calendar year, and this is just to verify benefits, it's not a guarantee of payment and then they only get uh $1250 per calendar year for outpatient and those benefits go towards deductible, co-pay or co-insurance only.
[CUSTOMER][NEUTRAL] And then um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, so all this, uh, all this, uh, balance on words, uh, go for patient responsibility, or yes, uh, like, uh, coinsurance, is it?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Like we had the patient responsibility or the co-insurance. All the deductible was uh sent to next responsibility party, right? Or if there was another insurance, uh, the balance will go to another insurance or it will bill to the patient.
[CUSTOMER][NEUTRAL] Isn't?
[AGENT][NEUTRAL] Uh, again, I can't give patient responsibility. We paid our part.
[CUSTOMER][NEUTRAL] OK. I understood, I understood. You have paid your part and the balance was sent to next uh like next insurance or like co-insurance, is it?
[AGENT][NEUTRAL] Well, I can't answer that. The, the claim was, the claim was paid.
[CUSTOMER][NEUTRAL] The balance was sent, uh, the balance.
[AGENT][NEUTRAL] I can't tell you what to do with the balance.
[CUSTOMER][NEUTRAL] OK, OK. I
[CUSTOMER][NEUTRAL] OK, OK, I understood. And can you please send this this all EOB also because we are not having any remit codes for this EOB. Uh, could you please send, uh, the complete EOB to to to faxes.
[AGENT][NEUTRAL] Yes, I sent it to the same fax number that I sent the other one to the [PII]. I've already done that.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, you have sent this, uh, 2, the 2nd account it will be also you have sent to the same fax number, right?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yes, I did.
[CUSTOMER][NEUTRAL] Yeah, done that. So I can use your call reference number, right?
[AGENT][NEUTRAL] Yes ma'am for both calls.
[CUSTOMER][NEUTRAL] Uh, your name and date, yes.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Yeah. Thank you, thank you so much for this information and, and have a good day. Thank you.
[AGENT][POSITIVE] You too. You have a good day too, [PII]. Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] Alright, well you take care and have a great day. Thanks for calling APL.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][POSITIVE] Thank you.