AccountId: 011433970860
ContactId: 5557e4f5-a52f-4e06-b91f-277e55351d3f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 947859 ms
Total Talk Time (AGENT): 209078 ms
Total Talk Time (CUSTOMER): 237333 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/5557e4f5-a52f-4e06-b91f-277e55351d3f_20250522T20:01_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII]. I'm from doctor's office. I'm checking on a claim here.
[AGENT][NEUTRAL] OK, I can verify claim status for you and I'm sorry, your name is again?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII].
[AGENT][NEUTRAL] OK, and [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] Yeah, the policy number I have here is uh
[CUSTOMER][NEUTRAL] 02415268 ML 7.
[AGENT][NEUTRAL] OK, thank you, one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII].
[AGENT][NEUTRAL] OK, and the date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] Uh, the data service for the client is, uh, [PII].
[CUSTOMER][NEUTRAL] 3333.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] And the amount of the charge?
[CUSTOMER][NEUTRAL] $2,032.
[CUSTOMER][NEUTRAL] I get the perman of status.
[AGENT][NEUTRAL] OK, and do you have the balance after primary?
[CUSTOMER][POSITIVE] will deliver this.
[CUSTOMER][NEUTRAL] A lot it.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][POSITIVE] Sorry? Yeah, sorry about that.
[AGENT][NEUTRAL] You, you're fine. Do you have the balance after primary?
[CUSTOMER][NEUTRAL] It's $75.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] And your name?
[AGENT][NEUTRAL] It's [PII], last initial [PII] and you said for date of service [PII], correct?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what is the name of the provider's office?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, provider's office name is uh.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK. South Miami Critical In Incorporation.
[AGENT][NEUTRAL] OK, I'm showing that claim process as the benefits of Max for the data service.
[CUSTOMER][NEUTRAL] How the benefit is matched for?
[CUSTOMER][NEUTRAL] Is it based on their visits or based on the dollars?
[AGENT][NEUTRAL] Based on dollar.
[CUSTOMER][NEUTRAL] How many dollars is allowed?
[AGENT][NEUTRAL] Um, for the, the insurance policy for outpatient, the max benefit is 40 $400 per calendar day. And so for that data service, they have already met that benefit max.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Per calendar day, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But they are uh maxed out, right?
[AGENT][NEUTRAL] Yes, for that data service, they've already met their benefit max.
[CUSTOMER][NEUTRAL] So this comes from the patient liability, right?
[AGENT][NEUTRAL] Uh, you have to contact the patient. We can't give patient responsibility. We can only verify how the claim was processed.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, what is the claim number for this one?
[AGENT][NEUTRAL] Uh, claim number is 3580149.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] 49, right?
[AGENT][NEUTRAL] Yes, 3580149.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] And the reference number for the call?
[AGENT][NEUTRAL] Uh, we don't give reference numbers, but if you like, you may use my name in today's date.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you help me with the next claim?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Is it for the same patient or a different patient?
[CUSTOMER][NEUTRAL] Uh, I need to check out. Uh.
[AGENT][NEUTRAL] Is the next claim for a different patient or the same patient?
[CUSTOMER][NEUTRAL] Yeah, I'm checking that one moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is many dukes
[AGENT][NEUTRAL] OK, so it's for a different patient?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] OK, give me one moment, please.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and what is the next policy number?
[CUSTOMER][NEUTRAL] I want that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, the policy number I have here is, uh,
[CUSTOMER][NEUTRAL] 02559856
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Was [PII].
[CUSTOMER][NEUTRAL] Uh, the date of birth I have here is um.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And the bill amount on the climb it is uh.
[CUSTOMER][NEUTRAL] $1,414.
[AGENT][NEUTRAL] Paying the balance after what a month or so second here give me one moment.
[CUSTOMER][NEUTRAL] No, this is only the primary insurance, yes.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And the name of the provider's office?
[CUSTOMER][NEUTRAL] Uh, yeah, the provider's office name I have here is um.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] RH emergency medicine so call.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, show the claim process is the benefit maximum for the data service has been met.
[CUSTOMER][NEUTRAL] Is based on the dollar. How many dollars is allowed?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Uh, with this patient's policy, the max payable is up to
[AGENT][NEUTRAL] $75 per visit up to $5 dollars per year, and they've already met the max for the year of the 5 visits.
[CUSTOMER][NEUTRAL] $25 right? $25 right?
[AGENT][NEUTRAL] $75.
[CUSTOMER][NEUTRAL] $75 for $5 per year, right?
[AGENT][POSITIVE] Correct, they've met the benefit max of the dollar value of $75 for that data service.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] 5 visits per year for $75 or.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK and um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Selling more the next claim?
[AGENT][NEUTRAL] Same patient or different patient?
[CUSTOMER][NEUTRAL] Different patient?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, what is the next policy number?
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, next, the policy number I have here is uh.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] It is 1993963.
[AGENT][NEUTRAL] OK, and the patient's name, date of birth?
[CUSTOMER][NEUTRAL] My patient name is uh [PII].
[CUSTOMER][NEUTRAL] Uh, date of birth, [PII].
[AGENT][NEUTRAL] OK, data service amount on the charge.
[CUSTOMER][NEUTRAL] Uh, [PII] and the charge amount on the claim.
[CUSTOMER][NEUTRAL] 1,273.
[AGENT][NEUTRAL] Balance after primary.
[CUSTOMER][NEUTRAL] $125.
[AGENT][NEUTRAL] What was the balance of primary, sorry.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] $125.
[AGENT][NEUTRAL] OK, name of the provider's office?
[CUSTOMER][NEUTRAL] 1 2nd.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, the provider's office name is um.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] [PII] Critical Care.
[AGENT][NEUTRAL] OK, I'm showing the claim process, the max benefit for the occurrence has been met.
[CUSTOMER][NEUTRAL] Mhm. How many dollars allowed?
[AGENT][NEUTRAL] Uh, up to 500 per current, so they've already met that max.
[CUSTOMER][NEUTRAL] I understand calendar year, right?
[AGENT][NEUTRAL] Per occurrence.
[CUSTOMER][NEUTRAL] Per current, current, right?
[AGENT][NEUTRAL] No, per occurrence.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I just uh lost 2 more. Can I help you with that?
[AGENT][NEUTRAL] Different patient.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, what is next policy number?
[CUSTOMER][NEUTRAL] Uh, the policy number I have here is uh 02336128ML8.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Patient's name, date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][NEUTRAL] OK, data service amount of the charge.
[CUSTOMER][NEUTRAL] Later service for the client is um.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Charge amount on the claim is 1,273.
[AGENT][NEUTRAL] Balance at the primary.
[CUSTOMER][NEUTRAL] 5223.
[AGENT][NEUTRAL] I'm sorry, balance after primary?
[CUSTOMER][NEUTRAL] $52.23.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, I'm sure that claim processes benefits of max for the data service as in dollar value, insure it has an outpatient benefit that pays up to $250 per day. They've already met the benefit for that data service.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, uh.
[CUSTOMER][NEUTRAL] What is the claim number?
[AGENT][NEUTRAL] 359-585-0.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] All right. Thank you.
[CUSTOMER][POSITIVE] Thank you have a great day bye.
[AGENT][POSITIVE] Alright, you're welcome. Thanks for calling APO Roger. Bye.