AccountId: 011433970860
ContactId: 3427ee72-c1c0-4210-88aa-932814b63bdb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 352119 ms
Total Talk Time (AGENT): 143079 ms
Total Talk Time (CUSTOMER): 235708 ms
Interruptions: 12
Overall Sentiment: AGENT=1.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/3427ee72-c1c0-4210-88aa-932814b63bdb_20250227T13:43_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from provider's office to check on a claim status.
[AGENT][POSITIVE] Uh, [PII], it would be my pleasure to assist you with that claim status. What is a good callback number in case we get disconnected, please?
[CUSTOMER][NEUTRAL] Well.
[CUSTOMER][NEUTRAL] Thank you. My callback number is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And [PII], what is the policy number for the patient, please?
[CUSTOMER][POSITIVE] I'm good bro.
[CUSTOMER][NEUTRAL] That's 02455948.
[AGENT][NEUTRAL] Thank you, [PII] and the patient's name and date of birth.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] All right, thank you. And this is for dental claim status?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] No, medical.
[AGENT][NEUTRAL] Medical cause that is a dental policy. Let me see if she has medical with us as well.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Bear with me just one moment.
[AGENT][NEUTRAL] All right, she does have medical coverage with us. Can I give you her medical policy number?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The policy number for medical coverage for [PII] is 245.
[CUSTOMER][NEUTRAL] Ah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 594 7.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. OK, one moment. OK, can I have that effective date and the termination date of that?
[AGENT][NEUTRAL] Effective date is [PII]. The policy termed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And I can check to see if we have that claim on file. What is the data service?
[CUSTOMER][NEUTRAL] 1.
[CUSTOMER][NEUTRAL] OK. Uh, date of service is on [PII].
[AGENT][NEUTRAL] And the bill amount, please.
[CUSTOMER][NEUTRAL] $7,456.50.
[AGENT][NEUTRAL] OK, thank you. And what is the name of the facility, please?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] That's Ohio Health Burger Hospital.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] On another claim what about?
[AGENT][NEUTRAL] I'm checking, bear with me just one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] Thank you, [PII], we did receive that claim. We placed it on the correct policy for you and processed.
[CUSTOMER][NEUTRAL] yeah mm mhm.
[AGENT][NEUTRAL] The claim. The claim was received on [PII].
[AGENT][NEUTRAL] And processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And was denied as the benefit maximum for that date of service has been met.
[CUSTOMER][NEUTRAL] I got I think I'm like, yeah, that.
[CUSTOMER][NEUTRAL] Can I have the claim number?
[AGENT][NEUTRAL] Claim number is 347.
[CUSTOMER][NEUTRAL] Look
[AGENT][NEUTRAL] 2475.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] 34. We have also received a payment of $500 even.
[AGENT][NEUTRAL] Yes, so that was for Burger Hospital also, but it was a different build amount.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] $500.
[AGENT][NEUTRAL] That was the payment amount, yes sir, and that was that maxed out the benefit for for that data service.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. So you have paid on since, uh, you will pay only $500 per claim.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] For a date of service, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. And this $500 is for different claim, not this claim.
[AGENT][NEUTRAL] That's right, it was for a different build amount.
[CUSTOMER][NEUTRAL] OK. Uh, just for the, uh, clarification, you will pay just $500 per date of service as for the patient's plan.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] So the entire $7,456.50 is no patient responsibility, right?
[AGENT][NEUTRAL] Well, we don't determine patient responsibility. We're not major medical.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] That would be determined by the provider.
[CUSTOMER][NEUTRAL] OK, fine, I can understand.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Uh, I have a doubt actually. Per day, uh, is that a claim calculation or the date of service calculation, you'll pay, uh, $500 for the date of service or $500 for a claim.
[AGENT][NEUTRAL] Is per date of service.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. As the patient's plan, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, fine. So, can I have the call reference number?
[AGENT][NEUTRAL] The call reference number is my name and today's date, and I spell my name [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh thank you, sir. Thanks for the information. Have a great day. Bye-bye. Thank you.
[AGENT][POSITIVE] It's been a pleasure to assist you with that claim status, [PII]. Anything else I can help you with before you go?
[CUSTOMER][NEUTRAL] One.
[CUSTOMER][POSITIVE] No, that's it. Thank you.
[AGENT][POSITIVE] Thank you for calling APL. I hope you have a wonderful day.
[CUSTOMER][POSITIVE] You're welcome. Thank you.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Um.