AccountId: 011433970860
ContactId: 3df6e431-b499-4b1c-8758-aa9a75399f21
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 263320 ms
Total Talk Time (AGENT): 95670 ms
Total Talk Time (CUSTOMER): 96896 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/3df6e431-b499-4b1c-8758-aa9a75399f21_20250321T14:00_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] Hey, my name is [PII]. I was calling from Baptist Medical Center. I was needing some help with a claim for a patient.
[AGENT][NEUTRAL] OK, I can definitely help you with the claim status, [PII], and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII] is my direct line.
[AGENT][NEUTRAL] Thank you. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Um, the one we have is 01947645 M as in Mary.
[CUSTOMER][NEUTRAL] L as in Larry 7.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Yes, um, [PII].
[CUSTOMER][NEUTRAL] Total charges is $222,312.68.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Baptist Medical Center.
[AGENT][NEUTRAL] Alright, hold on one moment.
[AGENT][NEUTRAL] All right, so I'm showing received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 348.
[AGENT][NEUTRAL] 641 9.
[AGENT][NEUTRAL] And on July
[CUSTOMER][NEUTRAL] You said 3486419?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] And then on [PII], the claim was denied.
[AGENT][NEUTRAL] Because the maximum amount payable for this occurrence has been met.
[CUSTOMER][NEUTRAL] Max amount pay you said max amount payable.
[AGENT][NEUTRAL] For this occurrence?
[CUSTOMER][NEUTRAL] For what now?
[CUSTOMER][NEUTRAL] OK, that's OK.
[AGENT][NEUTRAL] Has been met.
[CUSTOMER][NEUTRAL] Has the
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, is there a way that you'll be able to send me an EOB? Um, we didn't get one, so that's why I was trying to call to see if you guys even got a claim from us.
[AGENT][POSITIVE] Oh, yes, I can fax it to you. What's a good fax number?
[CUSTOMER][NEUTRAL] It's 732.
[CUSTOMER][NEUTRAL] 790.
[CUSTOMER][NEUTRAL] 0132
[AGENT][NEUTRAL] And should I put attention to [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am, that's [PII]
[CUSTOMER][NEUTRAL] And um just a uh quick question is there any patient responsibility?
[AGENT][NEUTRAL] So we don't determine patient responsibility because we're not a major medical insurance company.
[CUSTOMER][NEUTRAL] Oh, OK, so if they had anything left over from the primary payer and you guys don't handle it, then it would just be billed to them if y'all don't handle it.
[AGENT][NEUTRAL] Well, that would be, that would depend on, it would depend on whatever the policy, how y'all handle it, um.
[AGENT][NEUTRAL] If it's written off, if it's billed, we just can't determine that.
[CUSTOMER][NEUTRAL] Oh, OK, OK, got you.
[CUSTOMER][POSITIVE] OK, OK, got you, thank you for that.
[AGENT][POSITIVE] You're welcome. So I'm gonna go ahead and fax the explanation of benefits over to you. And then was there anything else I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] No ma'am, that was it um would you happen to have a call reference number?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK, and then the day of the [PII]. All right, thank you so much for your help. I appreciate it.
[AGENT][POSITIVE] You're very welcome and thanks for calling APL. I hope you have a great weekend.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] Thank you. Bye bye.