AccountId: 011433970860
ContactId: 4aedf3db-f845-4232-85c2-9af50208f499
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 486010 ms
Total Talk Time (AGENT): 181521 ms
Total Talk Time (CUSTOMER): 123232 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/4aedf3db-f845-4232-85c2-9af50208f499_20250311T13:33_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from By Scott to check on claims.
[AGENT][NEUTRAL] Sure, I can assist you with claims and you say your name is [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII]. And uh could you spell your name for me?
[AGENT][NEUTRAL] OK. That's [PII].
[AGENT][NEUTRAL] And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure. My callback number is [PII], and my extension is [PII].
[AGENT][NEUTRAL] OK, thank you. May I have the patient's policy number?
[CUSTOMER][NEUTRAL] Sure. The patient's policy number is 01.
[CUSTOMER][NEUTRAL] 896-422.
[AGENT][NEUTRAL] OK, you're coming in and out um can you repeat that number one more time it's missing an agent.
[CUSTOMER][NEUTRAL] Sure. 01896422.
[AGENT][NEUTRAL] And may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII] and the bill amount is 9300 and
[CUSTOMER][NEUTRAL] $64.85.
[AGENT][NEUTRAL] OK, let me see if I can find this claim for you, and that was [PII], correct?
[CUSTOMER][NEUTRAL] No, [PII].
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] Right, and for the future you can check claim status online through our website at [PII] and that's just optional and bear with me just a minute, let me pull this ERB.
[AGENT][NEUTRAL] I'm still waiting on the system.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so it looks like we processed the claim on [PII] and we send a benefit amount of $428.07.
[AGENT][NEUTRAL] It looks like with the payment of this uh check, the maximum benefit has been exhausted for the year.
[CUSTOMER][NEUTRAL] OK, thank you. And uh may I get the date and claim number?
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] Alright, let me get that for you. That's not on the EOB one moment.
[AGENT][NEUTRAL] Um, let me get the receipt please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, I'll wait on the received day. I can give you the claim number. The claim number is 3558534.
[AGENT][NEUTRAL] And it was received on [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So, make it the allowed under the paid amount?
[AGENT][NEUTRAL] OK, we're not the major medical. I can give you the pay amount because we're just the secondary.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the paid amount is $428.07.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Of the amount that the major medical applied towards the deductible co-payment and co-insurance was um $732.69.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] A Medicare, uh sorry, the primary insurance BCBS.
[CUSTOMER][NEUTRAL] I gave a coinci instance of $644.62 and the deductible is $88.
[CUSTOMER][NEUTRAL] You guys only paid $428.07. And what about the balance amount?
[AGENT][NEGATIVE] Again, and that's the reason I gave you the denial for the rest. Um, the reason we pay $428.07 is because with the payment of this check, the policy maximum for this benefit has been met, so she has exhausted her benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, may I get the maximum benefit details?
[AGENT][NEUTRAL] I'm sorry, can you repeat what you said?
[CUSTOMER][NEUTRAL] And uh may I get the maximum benefit details?
[AGENT][NEUTRAL] Sure, the outpatient maximum is 2000 per person per calendar year.
[CUSTOMER][NEUTRAL] ISP.
[CUSTOMER][NEUTRAL] So you guys allow and pay $2000 per calendar year.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And patient
[CUSTOMER][NEUTRAL] 2000, right.
[AGENT][NEUTRAL] Yes, with the payment of the $428.07 she maxed out that benefit of $2000.
[CUSTOMER][NEUTRAL] The, OK, that's the balance amount of 2000, right? That's only you paid it.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And may I get the patient plan name?
[AGENT][NEUTRAL] This is a secondary supplemental plan to the major medical.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] And could you confirm the, the balance of the patient response, right?
[AGENT][NEUTRAL] It's up to the provider's discretion. We don't have any contractual involvement on the remaining of the claim.
[CUSTOMER][NEUTRAL] OK, so thank you. So, and may I get the last main date, last previous payment for this number?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] We cannot really use that information. I can only give you information regarding your claim and based on the information of your claim, that was the last payment we send out the $428.07.
[AGENT][NEUTRAL] What's the one that completed that 2000.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm. Sure.
[CUSTOMER][NEUTRAL] So may I get the call for this call, [PII].
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][POSITIVE] Thank you, sir. I really appreciate your assistance and have a wonderful day.
[AGENT][POSITIVE] You're welcome. You as well. Thank you for calling APL. Bye-bye, Mr. [PII].
[CUSTOMER][NEUTRAL] Bye.