AccountId: 011433970860
ContactId: 30462221-4b18-499a-9289-077f0e35b4ea
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 238880 ms
Total Talk Time (AGENT): 121151 ms
Total Talk Time (CUSTOMER): 117681 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/30462221-4b18-499a-9289-077f0e35b4ea_20250103T15:41_UTC.wav
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[AGENT][NEUTRAL] How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm sorry, who was this?
[AGENT][NEUTRAL] This is [PII].
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] over on the care team. How are you today?
[AGENT][NEUTRAL] I'm fine. How are you?
[CUSTOMER][NEUTRAL] Doing good thank you um I was wondering if you could help me out. I have a uh insured on the line calling regarding a claim. Um, she's a bit confused. Uh, we paid $35 she sees on the EOB where it says total bill charges $616. Um, I can't see. I looked in on base and I'm not able to see what was submitted to us. I'm assuming that that's what it the balance was before major medical.
[CUSTOMER][NEUTRAL] Um, but I wanted just wanting to make sure, especially since she hasn't heard from that provider, but she wanted to make sure that that was it.
[AGENT][NEUTRAL] Yes, of course. Um, what is the policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, it is 0247.
[CUSTOMER][NEUTRAL] 3029.
[AGENT][NEUTRAL] Thank you. And the insured's name and date of date of birth?
[CUSTOMER][NEUTRAL] Um, it's [PII]. Give me just a moment, hang on.
[CUSTOMER][NEUTRAL] For for [PII] I think is how you say the last name. Um, date of birth is uh [PII].
[AGENT][NEUTRAL] Of course, let me see what I've got here.
[AGENT][NEUTRAL] Looks like this is just done.
[CUSTOMER][NEUTRAL] And she confirmed the 35 is usually what she would pay out of pocket and so again that's what I'm assuming I know sometimes on our EOBs when it says total bills charges that's before primary pays.
[AGENT][NEUTRAL] Right, right, yeah.
[CUSTOMER][NEUTRAL] But and that's again what I'm assuming but I don't, I don't see what was submitted to us. I looked in on Base and all I can see is our EOB.
[AGENT][NEUTRAL] Oh right, of course, um.
[AGENT][NEUTRAL] Let me see what we've got here.
[AGENT][NEUTRAL] OK, so this is for late imaging. Um, it looks like she had, uh,
[AGENT][NEUTRAL] Some sort of scan done. Now, um, the original, uh, cost of this, uh, is, is you were mentioning a $616. Um, now, what ended up happening is, is that the, uh, um,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Her total, her total patient responsibility is at $35. Uh what they did was the provider paid $111.30 and, uh, it looks like they uh they approved, they only allowed.
[AGENT][NEUTRAL] Um, $146.30. So the, the billed amount may have been $616 but the, uh, uh, Blue Cross and Blue Shield, which is her major medical, only allowed 14,630. So, uh, her, her responsibility was $35 which we paid and then Blue Cross and Blue Shield paid 111,130 cents. So, um, she doesn't owe any, she probably hasn't heard anything from the, uh,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Uh, provider because it's been, it's been taken care of. It's been paid in full as far as
[CUSTOMER][NEUTRAL] That's what I assumed. OK, yes, I appreciate you verifying that. So going forward, so I don't have to bug y'all more than I have to, um, is it probably be safe to assume those total bills charges that's, and especially if that's not what we show what we were billed, um, out of the payment, um, that's gonna be before primary that's what I've kind of noticed, but is that safe to assume?
[AGENT][POSITIVE] It is, but you know, um, if you ever have any questions, that's actually what we're here for, so, uh, and if you wanna send them over to us to talk to, you know, but, but yeah, um, absolutely, uh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You know, that's, that is what you, that's usually what that means, but if you ever have any questions, um please uh just um let us know and we're here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] I sure appreciate it. I like trying to do it myself, but that's what I like you teaching, yes.
[AGENT][POSITIVE] No, no, of course, but if you have any questions, no, if you're not begging us at all, that's really what we're supposed to be doing. So, um, uh, it's helping you guys. Sure, if any questions, just let me know. Otherwise have a good weekend. Thanks for letting me.
[CUSTOMER][POSITIVE] Well, I sure appreciate it. Thank you, [PII]. Absolutely, yes.
[CUSTOMER][POSITIVE] You too. Thank you so much. Bye.
[AGENT][NEUTRAL] Mhm bye.