AccountId: 011433970860
ContactId: 571c1f8d-98a5-47d3-a693-f2785a492ef3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 460609 ms
Total Talk Time (AGENT): 169771 ms
Total Talk Time (CUSTOMER): 137056 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/571c1f8d-98a5-47d3-a693-f2785a492ef3_20250117T19:00_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling from Oxford Diagnostic Center to check on a claim status. Could you please help me with that?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yeah, I'd love to help you with the claim status today. Do you mind, Miss [PII], if I grab your callback number?
[CUSTOMER][NEUTRAL] Yes, sure. My callback number is [PII].
[AGENT][NEUTRAL] Thank you. And then the member's ID number?
[CUSTOMER][NEUTRAL] The member ID is 793337.
[AGENT][POSITIVE] Perfect, give me 1 2nd to get that pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. And would you be able to verify for me please your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, sure. The patient's name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Perfect. I do see that right here. Thank you. And what is the date of service for the claim we want to look at for [PII]?
[CUSTOMER][NEUTRAL] It's [PII] and the bill amount is $571 even.
[AGENT][NEUTRAL] Perfect and you said [PII], is that correct?
[CUSTOMER][NEUTRAL] No, it's [PII].
[AGENT][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] All right, let me take a look here for you. And what was the name of the facility again on file for this claim?
[CUSTOMER][NEUTRAL] It's Oxford Diagnostic Center.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I know.
[AGENT][NEUTRAL] And the tax ID?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] OK, perfect, one second.
[AGENT][POSITIVE] Alright, perfect. I believe I found your claim right here.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] I see for your claim, it looks like we received it.
[AGENT][NEUTRAL] I'm so sorry, let me go back to that date.
[AGENT][NEUTRAL] [PII]. It looks like we processed the claim on [PII].
[AGENT][NEUTRAL] And your claim number is 346-6876.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] I do show that the claim was denied. I have the reason stating that benefits have been applied to the $1000 calendar year deductible.
[CUSTOMER][NEUTRAL] So it's deductible, right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just a minute.
[AGENT][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Can I get the deductible amount?
[AGENT][NEUTRAL] Yes, it was a $1000 calendar year deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But here we bill the American public at for $37.50. Is that a bulk amount?
[AGENT][NEUTRAL] It's saying that the benefits for the claim were applied to the $1000 calendar year deductible.
[CUSTOMER][NEUTRAL] OK. Uh, may I know how much, uh, so far patient met?
[CUSTOMER][NEUTRAL] I see.
[AGENT][NEUTRAL] Like where their account, how much of their $1000 deductible they've met?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] For the [PII] calendar year?
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So it looks like by the end of [PII], they ended up meeting their full $1000 deductible.
[CUSTOMER][NEUTRAL] OK. So, um, may I know when they met?
[AGENT][NEGATIVE] I don't, I'm not able to provide that for you now.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so, uh, upon checking here, the patient made full $1000. So, uh, could you please reprocess the claim?
[AGENT][NEUTRAL] No, because the claim, the benefits that they would have been paid were applied to that deductible, um, but we can't reprocess it. They were applied to the deductible.
[AGENT][NEUTRAL] They did end up meeting it by the end of [PII], but your claim came through in June, so there was still 6 months after that of other, you know, benefits being added to that deductible for it to be met.
[CUSTOMER][NEUTRAL] OK, I understand that.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Could you please send me the copy of an EOB?
[AGENT][POSITIVE] Yeah, I can absolutely do that. I can send it through fax for you.
[CUSTOMER][NEUTRAL] Yeah, sure. Uh, can I provide the fax number?
[AGENT][NEUTRAL] Yeah, give me one moment to get it loaded, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. And do you want that made attention to yourself, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what's that fax number please?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] I have [PII], was that correct?
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][NEUTRAL] Alright, I'm hitting send on that now. It should come to you in about 15 minutes or so. Is there anything else I can do for you, Ms. [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, uh, no, [PII], that's it for today. Can I get the call reference number, [PII]?
[AGENT][NEUTRAL] Yeah, you betcha. It's gonna be my name, [PII], first initial, last name, [PII], and then today's date.
[CUSTOMER][POSITIVE] OK, thank you so much for.
[CUSTOMER][POSITIVE] Assisting me today. Have a wonderful day, at least. Stay safe. Bye-bye.
[AGENT][POSITIVE] Yeah, my pleasure, [PII]. You take care. Thank you. Bye bye.