AccountId: 011433970860
ContactId: 6430e5fe-7378-48c2-83f5-c168ddff067b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 350869 ms
Total Talk Time (AGENT): 97857 ms
Total Talk Time (CUSTOMER): 110242 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/6430e5fe-7378-48c2-83f5-c168ddff067b_20250219T15:44_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office to check on our clients.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] OK, I can verify claim status for you and your name is again?
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yes, ma'am. Can you hear me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm sorry. Is that your name? Spell that again for me, please.
[CUSTOMER][NEUTRAL] Sure, it is [PII]. Last name first be [PII]. Can I spell your name for documentation.
[AGENT][NEUTRAL] Sure, it's [PII], what is that policy number, please?
[CUSTOMER][POSITIVE] Thank you so much for that.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, policy number is gonna be 1 sorry for that. I just come again. It is 01823146 M as in Mike L as in Lima 8. OK.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Oh sure, I do have a call back uh callback number is gonna be [PII].
[AGENT][NEUTRAL] OK, and verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Our patient name is uh [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] Yeah, it is [PII]. Charge amount is $35,940.26.
[AGENT][NEUTRAL] OK, and what was the balance after primary process the claim?
[CUSTOMER][NEUTRAL] Uh, yeah, primary is processed as a deductible and co-payment of uh.
[CUSTOMER][NEUTRAL] Uh, deductible $4,771 and co-payment $300.
[AGENT][NEUTRAL] OK. So the balance after primary?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and you're calling from?
[CUSTOMER][NEUTRAL] The balance after primary is.
[CUSTOMER][NEUTRAL] My normal
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. Yeah. Go ahead.
[AGENT][NEUTRAL] Um, and not a guarantee of payment, just a verification of coverage. With this policy, we are secondary. We help with primary insurance deductible, co-pay, and or co-insurance.
[AGENT][NEUTRAL] And um you're calling from or the name of the provider's office?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh yes, I'm calling from uh
[CUSTOMER][NEUTRAL] Highly Hospital.
[AGENT][NEUTRAL] OK, I'm showing that claim paid 500 and with that um amount it matched the benefit for the data service.
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] Uh, is there any delay on this claim?
[AGENT][NEUTRAL] I'm sorry, say again.
[CUSTOMER][NEUTRAL] Yeah, is there any denial on this claim?
[AGENT][NEUTRAL] Um, shown on a claim, we paid 500 and with that payment, it matched the benefit for the data service.
[CUSTOMER][NEUTRAL] OK, maximum balance for the date of service, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, yeah, it is uh D or unit.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] May I know the mailing address and timely, yeah, may I know the Kala mailing address and timely.
[AGENT][NEUTRAL] I, there is not a time limit to submit a corrected claim, but you must submit a letter stating the reason for the correction.
[CUSTOMER][NEUTRAL] Lata go later.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, because I do have under payment of $4,271 what I just uh asking about is the, uh, denial on this claim. You stated that uh claim was denied for.
[CUSTOMER][NEUTRAL] From the date of service right?
[AGENT][NEGATIVE] I'm, I'm not understanding it. Say again, your phone cut out.
[CUSTOMER][NEUTRAL] Yeah, the call reference number.
[AGENT][NEUTRAL] Uh, we don't give reference numbers. You may use my name at today's date. And Ms. [PII], is there anything else I can assist you with today?