AccountId: 011433970860
ContactId: 412e2bd2-e2e5-42f7-87f5-c14cdcbedcd6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 469640 ms
Total Talk Time (AGENT): 133973 ms
Total Talk Time (CUSTOMER): 130173 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/412e2bd2-e2e5-42f7-87f5-c14cdcbedcd6_20250404T14:20_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from Mother Francis Hospital to check on your patient plan status.
[AGENT][POSITIVE] All right, [PII], I'm happy to check on a claim for you today. What's the patient's policy number?
[CUSTOMER][NEUTRAL] Which is uh 02449038.
[AGENT][NEUTRAL] And do you have a good callback number?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] And then the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient first name.
[CUSTOMER][NEUTRAL] [PII], date of birth of uh [PII].
[AGENT][NEUTRAL] Thank you for that. And then date of service?
[CUSTOMER][NEUTRAL] It's for uh [PII].
[AGENT][NEUTRAL] And the buildout?
[CUSTOMER][NEUTRAL] Building amount is 1 $1,08.80.
[AGENT][NEUTRAL] OK, one moment please.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so it looks like we did receive a claim for the state of service on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim was processed on [PII]. There was a benefit payment sent in the amount of $25 in a single check.
[CUSTOMER][NEUTRAL] Can I get the check number?
[AGENT][NEUTRAL] 202-2594
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] One moment please. Could you please confirm that is any denial on this claim? any CPT code was denied.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, there was a denial for 87428 and 87,880.
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] May I know the reason for the delay?
[AGENT][NEUTRAL] The maximum benefit had been paid.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] It's $100 limit or receipt limit?
[AGENT][NEUTRAL] Uh, it looks like it was the
[AGENT][NEUTRAL] Maximum benefit towards an office visit. So it's the maximum dollar amount it was going to provide.
[CUSTOMER][NEUTRAL] So, may I know how much is the dollar for this patient as for the benefit plan?
[AGENT][NEUTRAL] The benefit amount was $25 and that was the max benefit for this uh date of service.
[CUSTOMER][NEUTRAL] So, OK, just a moment, please. Just one quick moment.
[CUSTOMER][NEUTRAL] Uh, just one quick second please.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you for patiently waiting. Could you please help me with the claim number?
[AGENT][NEUTRAL] Claim number is 355-0797.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So the remaining amount is has been applied to the patient responsibility, right?
[AGENT][NEUTRAL] We're not able to advise on patient responsibility that's up to the facility or provider to build the patient.
[CUSTOMER][NEUTRAL] So on this claim, you, may I know the total allowed amount?
[AGENT][NEUTRAL] The $25 that was paid.
[CUSTOMER][NEUTRAL] So you're allowed to pay the full amount, right, which is $25 no patient responsibility, and the rest of the two CPT code for maximum benefits exhaus still under the dollar limit, right?
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] Correct, it's the maximum benefit payable.
[CUSTOMER][NEUTRAL] Me the patient
[CUSTOMER][NEUTRAL] Pay the patient benefits, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] You know the patient plan type?
[AGENT][NEUTRAL] We are the secondary insurance. This is a Medlink plan.
[CUSTOMER][NEUTRAL] The kind of PP or HMO plan?
[AGENT][NEUTRAL] Neither, it's a secondary plan.
[CUSTOMER][NEUTRAL] OK, ma'am. Um, could you please, uh, spell out your name for me?
[AGENT][NEUTRAL] My name is spelled [PII].
[CUSTOMER][NEUTRAL] Your last name first [PII].
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Thank you for that. And uh can you, uh, OK, can I get the check issued and cleared it?
[AGENT][NEUTRAL] Issued on [PII].
[CUSTOMER][POSITIVE] It was clear.
[AGENT][NEUTRAL] Uh, check was cashed. I don't have a clear date.
[CUSTOMER][NEUTRAL] Just a second please.
[CUSTOMER][NEUTRAL] Could you please confirm the check me to address.
[AGENT][NEUTRAL] It was sent to [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Could you please repeat one more time the mailing address is a [PII]?
[AGENT][NEUTRAL] It was [PII] in [PII].
[CUSTOMER][POSITIVE] OK, thank you for the details so.
[CUSTOMER][NEUTRAL] I think that's all actually. Could you please help me with the uh
[CUSTOMER][NEUTRAL] Call reference number for this patient.
[AGENT][NEUTRAL] Call references my name with my last initial than today's date. My name again is [PII], last initial [PII], then today's date.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] Thank you for the information. Yeah, that's it for today. Have a wonderful day. Bye for now.
[AGENT][NEUTRAL] You too, [PII]. Bye bye.