AccountId: 011433970860
ContactId: 4474c405-96ec-4099-9d16-2f9bfef383af
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 568500 ms
Total Talk Time (AGENT): 148220 ms
Total Talk Time (CUSTOMER): 219395 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/4474c405-96ec-4099-9d16-2f9bfef383af_20250501T17:25_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hey [PII], it's [PII] and Broker Resources. How are you?
[AGENT][NEUTRAL] I'm doing fine. How are you?
[CUSTOMER][NEUTRAL] I'm well. I have [PII] on the phone and she is with group number 17328.
[CUSTOMER][NEUTRAL] And she is calling about a meddling claim for, and I have a policy or yeah, I have a policy number whenever you're ready.
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] Um, 235-7140.
[CUSTOMER][NEUTRAL] And the insured's name, first name is [PII], and I did um verify with the last four of the social.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And she's just calling to see if she can get an update.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Thank you I appreciate you. I hope you have a good day.
[AGENT][POSITIVE] Thank you too. Bye-bye.
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][POSITIVE] Hey [PII], I have the meddling claims department on the line for you and they'll help from here, OK? OK thank you have a great day. You too.
[AGENT][NEUTRAL] Good afternoon, [PII]. Are you with the provider?
[CUSTOMER][NEUTRAL] I'm with the brokerage office.
[AGENT][NEUTRAL] Broker's office, OK. And do you have a callback number I can get in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] And what's the patient's name?
[CUSTOMER][NEUTRAL] The patient's name is uh [PII] or [PII]
[CUSTOMER][NEUTRAL] [PII], I'm sorry, it's weirdly spelled.
[CUSTOMER][NEUTRAL] Um, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what's the date of birth?
[CUSTOMER][NEUTRAL] It's the uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] One second, I'll get that for you.
[CUSTOMER][NEUTRAL] I know
[CUSTOMER][NEUTRAL] Dependent.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And you were just needing claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, for what date of service was that for?
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][NEUTRAL] OK, hold on one moment, I'll look that up for you.
[CUSTOMER][POSITIVE] OK thanks.
[AGENT][NEUTRAL] Was it for the facility bill or was it for a doctor's charge?
[CUSTOMER][NEUTRAL] I believe it's a facility bill.
[AGENT][NEUTRAL] OK, we on the facility bill now we pay $2000.
[AGENT][NEUTRAL] On the
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] On the doctor's bill we denied for outpatient Max met.
[CUSTOMER][NEUTRAL] Tonight
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, OK.
[CUSTOMER][NEUTRAL] Uh oh.
[CUSTOMER][NEUTRAL] No bueno. uh OK.
[CUSTOMER][NEUTRAL] Is there a document you can email me that that has the information that I could pass along to them?
[AGENT][NEUTRAL] I don't have anything that I can email to you. They can go on our online service center and see all of it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Online.
[CUSTOMER][NEUTRAL] Like a member portal?
[AGENT][NEUTRAL] Yes, ma'am. They would be able to see all of their claims and everything.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEGATIVE] So, so $2000 was paid towards the facility and for the doctor, it was denied for outpatient maps.
[AGENT][NEUTRAL] For
[AGENT][NEUTRAL] Right, because we paid the facility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty uh do do do.
[CUSTOMER][NEUTRAL] OK, well, I, I guess I'll just have to let them know that um because I guess they were, they were waiting on, on an answer.
[AGENT][NEGATIVE] They should have gotten an EOB in the mail.
[CUSTOMER][NEUTRAL] For the for the.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] With their responsibility.
[AGENT][NEUTRAL] Uh, right, that, um.
[AGENT][NEUTRAL] Even if we pay the provider on the one we paid the provider, we always send the insured a copy as well.
[CUSTOMER][NEUTRAL] Oh OK, so, so no part of the provider side was was paid just the facility, right?
[AGENT][NEUTRAL] Right, we, we paid the facility.
[AGENT][NEUTRAL] And that max, all they get is 2000.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Per year for outpatient.
[CUSTOMER][NEUTRAL] OK. I do see this provided services. Mhm.
[AGENT][NEUTRAL] So when they
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] It looks like they filed the claim as well.
[AGENT][NEUTRAL] And it was done as a duplicate because we had already paid the provider.
[CUSTOMER][NEUTRAL] Oh, so there this is there's a duplicate claim for this state of service?
[AGENT][NEUTRAL] Right, we paid the provider.
[AGENT][NEUTRAL] The 2000
[AGENT][NEGATIVE] We denied the doctor's charge and then the insured sent in the claim after we paid the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sorry, I'm just making notes here.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Oh, you said the the provider was paid, but do you mean the facility?
[AGENT][NEUTRAL] Right, the facility bill was paid $2000.
[CUSTOMER][NEUTRAL] Because you said there was a.
[CUSTOMER][NEUTRAL] OK, but then there was a there was a provider charge.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] That was denied as Max [PII].
[CUSTOMER][NEUTRAL] Do you know how much the provider charge was?
[AGENT][NEUTRAL] Uh, $3,832.
[CUSTOMER][NEUTRAL] So that's something that they have to pay out of pocket now?
[AGENT][NEUTRAL] Yes, what, whatever is left over, they would be responsible for.
[AGENT][NEUTRAL] Whatever their major medical didn't pay.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK, yeah, I see the claim breakdown here a little over 800.
[CUSTOMER][NEUTRAL] Total, your total amount owed 24.
[AGENT][NEUTRAL] Now, the 8000 is for the facility bill.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEGATIVE] Which was denied because we already paid the facility.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh really. Oh.
[CUSTOMER][NEGATIVE] Oh, so, so they should have received them.
[CUSTOMER][NEUTRAL] EOB then I'm not sure why.
[CUSTOMER][NEUTRAL] They're coming to us.
[AGENT][NEUTRAL] Yes, ma'am. We always send the insured a copy of whatever we send the provider. They'll get a copy.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEGATIVE] Yeah, and since this was done back in January of last year they should have received everything, right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Not a problem then, uh, yeah, I'll go ahead and pass this information on to them.
[AGENT][NEUTRAL] OK. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] And they
[CUSTOMER][NEUTRAL] Um, no, not at the moment, thank you very much.
[AGENT][POSITIVE] Thank you, [PII], for calling API. You have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.