AccountId: 011433970860
ContactId: 653105e9-5689-42c3-bc43-609c395d4d22
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 436230 ms
Total Talk Time (AGENT): 135260 ms
Total Talk Time (CUSTOMER): 151091 ms
Interruptions: 2
Overall Sentiment: AGENT=0, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/653105e9-5689-42c3-bc43-609c395d4d22_20250116T16:34_UTC.wav
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[CUSTOMER][NEUTRAL] day.
[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][POSITIVE] Thank you for calling.
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] and I'm calling from Upper Valley Medical Center. And I'm calling in regards to a claim. It was, it, we have you listed as a secondary insurance, and when we billed you, it was processed as primary.
[AGENT][NEUTRAL] OK, do you have a callback number in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, it's 02389296 M as in Mary, L as in Larry, 8.
[AGENT][NEUTRAL] Thank you. Hold on one moment, please.
[CUSTOMER][NEUTRAL] All
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what's the patient's name?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and the last name is [PII]
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you, [PII], and you were just needing the claim status?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Well, not claim status actually I'm looking for, um, it was processed as primary that we built secondary it should be processed as secondary.
[AGENT][NEUTRAL] OK, I can look that up for you. What date of service?
[CUSTOMER][NEUTRAL] Data services [PII].
[AGENT][NEUTRAL] Was it for the emergency room facility bill?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on just a moment, I'm trying to pull up the claim.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, $4,238.40 went towards the coinsurance. That's what we paid.
[CUSTOMER][NEUTRAL] You paid 2000.
[AGENT][NEUTRAL] Right, but $4,238.40 went to the coinsurance on this EOB.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] OK, so what about, so what happens to the balance then the $2,238.41?
[AGENT][NEUTRAL] It would be patients responsibility because they had met their maximum for outpatient.
[CUSTOMER][NEUTRAL] OK, so they, uh they owe the whole $4,238.41. $2000 is a co-pay.
[AGENT][NEUTRAL] The 2000, we paid 2000.
[CUSTOMER][NEUTRAL] Or no, you paid 2000.
[CUSTOMER][NEUTRAL] And the 2000.
[AGENT][NEUTRAL] So they were
[CUSTOMER][NEUTRAL] $238.48 is their responsibility because they met their maximum.
[AGENT][NEUTRAL] Let's see, $4,238.40 went to their co-insurance.
[AGENT][NEUTRAL] And we paid 2000.
[AGENT][NEUTRAL] So they would have 223,840.
[CUSTOMER][NEUTRAL] It's their responsibility.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Can you fax me that remit because that's not what our remit shows.
[AGENT][NEUTRAL] The, uh, EOB?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Now we paid the 2000 and whatever is left over is their responsibility.
[CUSTOMER][NEUTRAL] Please.
[CUSTOMER][NEUTRAL] And that's because they match up.
[AGENT][NEUTRAL] We don't have any write offs we don't have um anything like that we don't have a list of providers or anything like that. What we don't pay that's what.
[AGENT][NEUTRAL] They are responsible for, so we only pay $2000 so you all charge 5,008201.
[AGENT][NEUTRAL] You only allowed the primary allowed 42, 38, 40, so yeah, they would only be responsible for the 22, 3840.
[CUSTOMER][NEUTRAL] Be the primary.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, can you fax me that remit because the one that I have doesn't show any patient responsibility.
[AGENT][NEUTRAL] None of our show patient responsibility because we're not major medical.
[CUSTOMER][NEUTRAL] OK, can you fax me your remit just so I can see what it looks like? OK, that would be great.
[AGENT][NEUTRAL] It's gonna
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's gonna be the same one that you have.
[CUSTOMER][POSITIVE] Well, see, ours good.
[CUSTOMER][NEGATIVE] The billing company that we have somehow it default so it's not it doesn't match the original.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] What's your fax number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEGATIVE] OK, I'll fax that to you, but it's not gonna have the patient responsibility. All it's gonna show is that we paid $2000.
[CUSTOMER][NEUTRAL] OK, OK, and do you have a call reference number?
[AGENT][NEUTRAL] We do not have call reference numbers. You can use my name and today's date.
[CUSTOMER][POSITIVE] OK. All right, thanks [PII]. have a good day.
[AGENT][POSITIVE] Thank you, [PII], for calling APL. You as well.
[CUSTOMER][NEUTRAL] Bye bye.