AccountId: 011433970860
ContactId: 59cfd1fc-1348-49f9-bfad-0323b02ebf45
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 493679 ms
Total Talk Time (AGENT): 125892 ms
Total Talk Time (CUSTOMER): 287427 ms
Interruptions: 4
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/59cfd1fc-1348-49f9-bfad-0323b02ebf45_20250207T18:27_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hey, hi. Hey, sorry about that. Hey, hi, this is [PII] calling from the product office checking out a claim and you said your name is?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, can you help me with the claim?
[AGENT][NEUTRAL] Uh-huh, I can't hear you. What's the policy number?
[CUSTOMER][NEUTRAL] Yep, um, that's gonna be 021-823-41.
[AGENT][NEUTRAL] One moment please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] [PII], what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, that's gonna be [PII].
[CUSTOMER][NEUTRAL] Well
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth is [PII].
[CUSTOMER][NEUTRAL] You know.
[AGENT][NEUTRAL] Thank you for verifying that information for me and you said that you're checking claim status?
[CUSTOMER][NEUTRAL] Actually, not a claim status, ma'am. The claim has been denied for primary EOB and we just sent the primary EOB to you you on, OK, yeah, 12 to.
[AGENT][NEUTRAL] For what date of service?
[CUSTOMER][NEUTRAL] Yeah, it's gonna be [PII].
[CUSTOMER][NEUTRAL] And the total charge amount is $1,065 even $1065.
[AGENT][NEUTRAL] And when was the primary EOB sent to us?
[CUSTOMER][NEUTRAL] It was sent on [PII].
[AGENT][NEUTRAL] 122 24 and the total bill is $165?
[CUSTOMER][NEUTRAL] No, ma'am, it's $1,065 1065 dollars.
[AGENT][NEUTRAL] And is this the hospital charge?
[AGENT][NEUTRAL] The facility charge, facility charge?
[CUSTOMER][NEUTRAL] Facility claim.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I, I heard that I I actually looked at it and I don't know if I don't do it in order to actually do.
[AGENT][NEUTRAL] OK, so we did receive the explanation of benefits and paid a benefit of $300. Uh, this payment was processed on [PII].
[AGENT][NEUTRAL] What's the name of the facility?
[CUSTOMER][NEUTRAL] Cowell Health Dearborn or Coval Health [PII] Baymont.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And you said that the check, the EOB was submitted on what day?
[CUSTOMER][NEUTRAL] [PII] to 2024 and our outstanding balance is $258.56.
[AGENT][NEUTRAL] OK, so I'm
[CUSTOMER][NEUTRAL] I think the primary paid the yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And you said the date of service is [PII] total bill amount of $165 correct?
[CUSTOMER][NEUTRAL] No, um, charge amount is $1,065 1065 dollars.
[AGENT][NEUTRAL] 1065.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Are you saying 1065 or 1055?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 1065.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I show the date of service. I showed that total charge and then you said the name of the facility is Corwell Health Dearborn Hospital. I see that facility charge, um, but I'm showing that this claim processed back in July.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think [PII] OK, just give me one moment, ma'am.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What are you talking about.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You guys paid around $300 right? That's what you said.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] and the remaining balance.
[CUSTOMER][NEUTRAL] I could see the primary insurance paid around.
[AGENT][NEUTRAL] What about the remaining balance?
[CUSTOMER][NEUTRAL] Let me check, yeah, pay around $179.49 and.
[CUSTOMER][NEUTRAL] The remaining balance of $558.56 has been processed towards deductible, and you guys paid charge around $300 yeah, $300 you guys paid around $300 and the remaining balance is it under the patient responsibility or has been denied.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, we do not determine patients responsibility. That was the maximum benefit available. It's a calendar day benefit and so that was the the maximum benefit that was available or left for that date of service.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So the members have met.
[CUSTOMER][NEUTRAL] OK, got it. So the maximum benefit amount has been met, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And do you happen to have the med date?
[AGENT][NEUTRAL] I'm sorry, what type date?
[CUSTOMER][NEUTRAL] The maximum benefit met date.
[AGENT][POSITIVE] It's a daily benefit.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it covers up 2 to $300 per calendar day, which is the amount that was paid on this claim, so that's [PII] is when it was processed.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah yeah uh.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Any other questions, [PII]?
[CUSTOMER][POSITIVE] Thank you so much for that.
[CUSTOMER][NEUTRAL] No, ma'am. That's it from my end. And before that, can I have the claim number?
[AGENT][NEUTRAL] That claim number is 347.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] 7
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 840.
[CUSTOMER][NEUTRAL] Mhm that's a claim number, right?
[AGENT][NEUTRAL] Anything else?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No ma'am, that's it from my end and can I have the reference number for this call?
[AGENT][NEUTRAL] My name in today's date, [PII]
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Got it. Thank you. Thank you so much for that information, ma'am. Have a good day. Bye-bye. Take care.
[AGENT][NEUTRAL] First initial of my last name is [PII]
[AGENT][NEUTRAL] As in [PII].
[AGENT][POSITIVE] You're, you're welcome. Thanks for calling APL [PII].