AccountId: 011433970860
ContactId: 33895604-8a0a-48fb-ad02-f0cdfa824720
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 658590 ms
Total Talk Time (AGENT): 137560 ms
Total Talk Time (CUSTOMER): 209095 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/33895604-8a0a-48fb-ad02-f0cdfa824720_20250505T14:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, [PII]. This is [PII] calling from the provider's office, checking on the claim days. How are you doing today?
[AGENT][POSITIVE] I'm doing good, Molly. Um, do you have a uh good callback number?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][POSITIVE] OK. Thank you.
[CUSTOMER][NEUTRAL] [PII], can I have your name spelled out with your last initial, please?
[AGENT][NEUTRAL] Uh my name is [PII]. It's [PII] and then first initial to last name is [PII].
[CUSTOMER][POSITIVE] All right. Thank you.
[AGENT][NEUTRAL] And do you have the policy number for the patient, Molly?
[CUSTOMER][NEUTRAL] Um, yes, give me a moment.
[CUSTOMER][NEUTRAL] It's 02358065.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And the date of service and bill charges?
[CUSTOMER][NEUTRAL] Date of service is [PII] with the total bill amount $67 even.
[AGENT][NEUTRAL] OK, it looks like we received that claim on 10-2-2024.
[AGENT][NEUTRAL] It was processed 1010 2024.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, this is not a covered benefit under the policy.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is not covered under the patient's policy, you mean?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] All right. Can I have the member's plan for this?
[AGENT][NEUTRAL] The members, what do you mean?
[CUSTOMER][NEUTRAL] The member's plan? What policy is the member holding over here?
[AGENT][NEUTRAL] It's a hospital indemnity plan.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] All right. So, that doesn't cover under this service?
[AGENT][NEUTRAL] Correct, it's a supplemental policy.
[CUSTOMER][NEUTRAL] All right. So we need to be patient for this one?
[AGENT][NEUTRAL] This is a supplemental policy so we can't determine patient responsibility.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] All right. So can we do the patient for this one?
[AGENT][NEUTRAL] I, I can't instruct you to bill the patient because this is a supplemental policy, so I can't answer that question. I can't give you a yes or no.
[CUSTOMER][NEUTRAL] All right, sir. Thank you. And since this is a supplemental policy, this service doesn't cover under the plan. Is that correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] All right, got it. So can I get the claim number, [PII]?
[AGENT][NEUTRAL] 351234-3.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um, can I have the EUVa, please?
[AGENT][NEUTRAL] What's your fax number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'll get that faxed over. It just takes about 5 minutes.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Is there anything else I can help with today?
[CUSTOMER][POSITIVE] Yes, definitely. I do have the same memo with a different service and built around.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the data service and build them out?
[CUSTOMER][NEUTRAL] The the service is
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] with the total bill amount $216 even. That is 216.00.
[CUSTOMER][NEUTRAL] conversation.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, that was received 628-2024.
[AGENT][NEUTRAL] Process 71 2024.
[AGENT][NEUTRAL] And a payment of $30 was made.
[AGENT][NEUTRAL] By a single check.
[CUSTOMER][NEUTRAL] All right. And what is the denial over here?
[AGENT][NEUTRAL] What is the what?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] What is the denial over here?
[AGENT][NEUTRAL] The maximum benefit payable is $30.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] All right. Give me a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. So, $30 has been made. And um what about the remaining amount? Is it been a write-off or
[AGENT][POSITIVE] The maximum benefit.
[CUSTOMER][NEUTRAL] Because I did not have any.
[AGENT][NEUTRAL] The the maximum payable for this date of service for this benefit was $30. That's the max that we will pay.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right. So the maximum benefit has been met, you mean?
[AGENT][POSITIVE] The maximum benefit has been paid, yes.
[CUSTOMER][NEUTRAL] All right. Got it. Give me a moment.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Can I get what the patient has met, what the maximum benefit that has been allowed for the dollars? What is the total allowed dollar amount for the maximum benefit?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] The maximum benefit payable is $30.
[CUSTOMER][NEUTRAL] $30.
[CUSTOMER][NEUTRAL] Oh right
[CUSTOMER][NEUTRAL] Um, OK. It has been met exploding this claim?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Has it been met excluding this claim?
[AGENT][NEGATIVE] And met excluding this claim, I, I, I don't understand what that means.
[CUSTOMER][NEUTRAL] As the patient met the dollar amount excluding this claim.
[AGENT][NEUTRAL] This is a supplemental policy for this date of service, we have paid the total that can be paid of $30.
[CUSTOMER][NEUTRAL] All right, give me a moment.
[CUSTOMER][NEUTRAL] All right, can I get the check number and the check pay date?
[AGENT][NEUTRAL] Check number 1860447.
[CUSTOMER][NEUTRAL] All right, I'm gonna check pay it.
[AGENT][NEUTRAL] 71 [PII].
[CUSTOMER][NEUTRAL] It has been in cash on the same day?
[AGENT][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] Can I get the the address to which it's been paid?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] All right, give me a moment.
[CUSTOMER][POSITIVE] All right, thank you definitely for your assistance and you may have a great shift ahead. Bye for now.
[AGENT][POSITIVE] Thank you for calling APL. You as well. Bye-bye.