AccountId: 011433970860
ContactId: 321eb7e4-b5f9-4073-9d8d-b8f18e7203de
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 497079 ms
Total Talk Time (AGENT): 135001 ms
Total Talk Time (CUSTOMER): 110745 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/321eb7e4-b5f9-4073-9d8d-b8f18e7203de_20250311T16:20_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling for the claim status for one of our patients.
[AGENT][NEUTRAL] OK, I can help you with the claim status. Can I please get your name, callback number, and the facility you're calling from?
[CUSTOMER][NEUTRAL] [PII], the number is [PII].
[CUSTOMER][NEUTRAL] And I'm calling with Brownsville Surgery Center.
[AGENT][NEUTRAL] OK. All right, [PII]. Can you please give me the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] The patient's name is uh [PII]. Um, date of birth is.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] [PII], let me get that policy number.
[CUSTOMER][NEUTRAL] Policy number 2041464.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, let me look that policy up real quick.
[AGENT][NEUTRAL] OK, and that is 20.
[AGENT][NEUTRAL] 141464.
[CUSTOMER][NEGATIVE] Uh, no.
[CUSTOMER][NEUTRAL] No, uh, 20.
[AGENT][NEUTRAL] OK, can you repeat it?
[CUSTOMER][NEUTRAL] 41464.
[AGENT][POSITIVE] Oh got you. I added a one in there, OK.
[AGENT][NEUTRAL] OK, I've got Miss [PII] pulled up. Can you please give me the date of service and the charge amount?
[CUSTOMER][NEUTRAL] The date of service is [PII]. The amount $21,698.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Let me see the, the leftover um let me see.
[CUSTOMER][NEUTRAL] $2,736.50.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up this claim for you and I will be right back, Miss [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Come on computer.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you for holding for me, [PII]. I have the claim pulled up. The claim number is 354-0525.
[AGENT][NEUTRAL] The claim was paid $1,613.44.
[AGENT][NEUTRAL] With check number 2018102.
[AGENT][NEUTRAL] After that payment, it maxed out the benefit for the calendar year.
[AGENT][NEUTRAL] The check cleared the bank on [PII].
[AGENT][NEUTRAL] And it was made out to Brownsville Surgery Center.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] We do not have this payment let me see.
[CUSTOMER][NEUTRAL] Oh OK and then so.
[AGENT][NEUTRAL] They cleared the
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You're saying after this payment the benefits were maxed out.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So it's um like.
[AGENT][NEGATIVE] They were exhausted.
[CUSTOMER][NEUTRAL] Primary payer impact.
[CUSTOMER][NEUTRAL] Basically.
[AGENT][NEUTRAL] No. No.
[CUSTOMER][NEUTRAL] Or is it patient responsibility after that?
[AGENT][NEUTRAL] We don't give patient responsibility because that's up to the provider to determine that, but this policy goes by a certain dollar amount per year and once this check was paid it maxed out that amount for the year.
[CUSTOMER][NEGATIVE] So it's not um but you can't save patient responsibility after that.
[AGENT][POSITIVE] Correct. Right.
[CUSTOMER][NEUTRAL] Let me see what the EOB if I can pull the EOB and see what it says on there, do you have the EOB?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And on the EOB it doesn't show anything for patient responsibility.
[AGENT][NEUTRAL] I could
[AGENT][NEUTRAL] We don't give patient responsibility ever because that's determined by the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] What was your name?
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] [PII] and what is the uh reference number for this call?
[AGENT][NEUTRAL] You can use my name and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, thank you so much [PII] that's all I needed today.
[AGENT][POSITIVE] You're very welcome. I hope you have a wonderful day and thank you for calling APL.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye-bye, ma'am.