AccountId: 011433970860
ContactId: 4610b17f-4197-4324-a5d6-36e711c648a9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 684330 ms
Total Talk Time (AGENT): 238922 ms
Total Talk Time (CUSTOMER): 102735 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/4610b17f-4197-4324-a5d6-36e711c648a9_20250307T13:16_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII] as well. Um, I am calling, um, I have a question about a claim, please.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, are you calling from a provider's office, [PII]?
[CUSTOMER][NEUTRAL] Yes, I am calling from.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh, Samaritan Hospital of Troy.
[AGENT][NEUTRAL] OK, and how do you spell your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And mine's [PII].
[AGENT][NEUTRAL] OK, and [PII], so you have a question regarding a claim, is that correct? Claim status?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Um, yeah, the, well, the claim paid, but, um, the EOB doesn't show anything but the payment, so we don't know if there's an adjustment or if there's a patient responsibility.
[AGENT][NEUTRAL] Yes, ma'am, I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Direct line is [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] 02543325
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] And I see any information that I do provide for you today would be a verification of benefits and not a guarantee your payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And do you have, what is, well, first off, what is the data service and total bill amount please?
[CUSTOMER][NEUTRAL] Uh, 10 8 24 for $315.
[AGENT][NEUTRAL] 315.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim number?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Do you have the claim number already?
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] You said you had received.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I have 3560081.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, now on that claim number that one denied as a duplicate of previously submitted expenses.
[CUSTOMER][NEUTRAL] So there must be one prior to that.
[AGENT][NEUTRAL] OK, so the original claim.
[CUSTOMER][NEUTRAL] Um, oh, here's the one.
[AGENT][NEUTRAL] 3541932.
[CUSTOMER][NEUTRAL] Yeah, with the payment.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So yes, I can see that there was a $75 benefit paid on this claim.
[AGENT][NEUTRAL] Is that your reflection?
[CUSTOMER][NEUTRAL] Yeah, mhm, so is there any PPO discount or patient responsibility?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Now for any discount questions that would go, this is a limited benefit plan so that is the maximum benefit that this plan pays. Multipla is the network for this company which you say you would need to speak to regarding any discounts.
[CUSTOMER][NEUTRAL] OK, um.
[AGENT][NEUTRAL] But we do not determine patient responsibility. That is up to the provider.
[CUSTOMER][NEUTRAL] OK, um, benefit plan.
[AGENT][NEUTRAL] And if you need a, do you already have that explanation of benefits?
[CUSTOMER][POSITIVE] Yeah, we do, mhm, but yeah, it just says the $75 payment so um I'm gonna benefit plan um.
[AGENT][NEUTRAL] And then we, you know, for future reference, should you need a copy of an EOB that we don't have our check claim status, we do have a portal, Tracy.
[AGENT][NEUTRAL] That's located at [PII].
[AGENT][NEUTRAL] That you can set up your profile to have access.
[CUSTOMER][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] Um, if I needed to find out about the, um, provider discount, who do I contact?
[AGENT][NEUTRAL] Multipla, yes ma'am, uh huh.
[CUSTOMER][NEUTRAL] What plan?
[AGENT][NEUTRAL] And let's see.
[CUSTOMER][NEUTRAL] Is there one, yeah.
[AGENT][NEUTRAL] Uh-huh. I can give you their number. It is [PII].
[CUSTOMER][NEUTRAL] And I just need to give them the claim number?
[AGENT][NEUTRAL] You would, yes, ma'am. You would have to ask them, um, let me look at just one other thing while I'm looking at this policy.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Now they may just need a member's policy number. I'm not sure if they would be able to pull that up and they may just ask you for the data service.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And build them out like I initially did. I'm not sure how the process works with that.
[CUSTOMER][NEUTRAL] OK, I'll give them a call.
[AGENT][NEUTRAL] Now, I'll be happy to connect you over if you would like, [PII], but before I do that, is there anything else um that I can help you with?
[CUSTOMER][NEUTRAL] Uh, no, that's it.
[AGENT][POSITIVE] OK, well then, thank you very much for calling APL and I hope that you have a great weekend.
[CUSTOMER][POSITIVE] Thank you. You too.
[AGENT][POSITIVE] All right, you're very well let me.
[AGENT][NEUTRAL] I'm so sorry. I'm still looking at one thing on their discount, so give me just a second.
[AGENT][NEUTRAL] Let me just give me do you mind giving me a couple of moments to look at something else?
[CUSTOMER][POSITIVE] Yeah, no problem.
[AGENT][NEUTRAL] OK, I'm gonna place you on a brief hold, OK, if that's all right.
[CUSTOMER][POSITIVE] Sure, thank you.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Let's see how long this takes.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Uh
[AGENT][POSITIVE] [PII], thank you so much for holding for me. I really appreciate your patience while I was looking at this for you. So what I can do is I can send a request to have someone to return your call regarding repricing on this particular claim, um, and that number you gave me [PII], is that your direct line?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, mhm.
[AGENT][NEUTRAL] OK. So no other option or anything like that that'll take, do you have voicemail? Should you not be available?
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK. All right. Well, would you like for me to do that and then I can, you know, like I said, I'll just request somebody to look in this for you and give you a return call.
[CUSTOMER][POSITIVE] Yes, that would be perfect.
[AGENT][NEUTRAL] OK. Well, is there anything else then I'll do that right now. Is there anything else that I can help you with?
[CUSTOMER][NEUTRAL] Um, no, that's it.
[AGENT][POSITIVE] OK, well then, thank you so much for calling APL and I hope that you have a great day and a very nice weekend.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] All right, thanks, [PII]. Bye bye.