AccountId: 011433970860
ContactId: 6b7d8910-3a31-40a2-afc2-4ea53ca70ec8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1047458 ms
Total Talk Time (AGENT): 274238 ms
Total Talk Time (CUSTOMER): 267643 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/6b7d8910-3a31-40a2-afc2-4ea53ca70ec8_20250610T18:52_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from facility to check on the client status. Can you please spell your name?
[AGENT][NEUTRAL] Sure. My name is [PII]. Last initial [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] [PII], may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure. My callback number is [PII].
[AGENT][NEUTRAL] OK, thank you. May I have the
[CUSTOMER][NEUTRAL] And the extension is [PII].
[AGENT][NEUTRAL] [PII] extension. OK. May I have the name of the facility you're calling from for my notes?
[CUSTOMER][NEUTRAL] Uh, the facility name is Norton Auben Hospital.
[AGENT][NEUTRAL] You said Norther?
[CUSTOMER][NEUTRAL] Yes, Norton Aubin.
[AGENT][NEUTRAL] That's fine.
[AGENT][NEUTRAL] And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, uh, it is D as in Delta 42026474.
[AGENT][NEUTRAL] OK, thank you. And do you have a policy certificate number? It's gonna start with a 0 followed by 7 digits. That's gonna be our number.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] No, it doesn't have any number. We have only member ID.
[CUSTOMER][NEUTRAL] And the SSN number, that is social security number.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] May I have the spelling of the last name?
[CUSTOMER][NEUTRAL] Uh, the last name spelling, spelling is [PII].
[CUSTOMER][NEUTRAL] Who's last name, member's last name?
[AGENT][NEUTRAL] Yeah, member's last name so I can do a name search because that policy number is not our policy number, so we need to do a name search.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. It is [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so it's [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And what is the spelling of the first name?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] [PII]. OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me try it several ways because it's not pulling up. OK, one moment.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Should I give the member's address?
[AGENT][NEUTRAL] I need to search my name first in order to know the address, um.
[AGENT][NEUTRAL] OK, let me try it now without this. Do you have the social by any chance?
[CUSTOMER][NEUTRAL] Yes. It is [PII].
[AGENT][POSITIVE] OK, let me check one moment, thank you.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What is the date of birth?
[CUSTOMER][NEUTRAL] It was uh [PII].
[AGENT][POSITIVE] OK. Thank you.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] The date of services, uh, date range between [PII] and the total charge amount was $6,348 even.
[AGENT][NEUTRAL] [PII], the amount of $6,348 even.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Right
[CUSTOMER][NEUTRAL] To come.
[CUSTOMER][NEUTRAL] C as in
[CUSTOMER][NEUTRAL] I don't.
[CUSTOMER][NEUTRAL] You want it already.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I'm still searching. OK, one moment.
[CUSTOMER][NEUTRAL] A 111.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Ms. [PII], do you have the um the procedure codes?
[CUSTOMER][NEUTRAL] Uh, one moment, let me check.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Procedure codes.
[CUSTOMER][NEUTRAL] Uh, that are one moment.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh, we have, uh, several procedure code. I think we have 14 lines.
[CUSTOMER][NEUTRAL] I think I have a claim number here. Can you please check whether that is uh.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It is 202-504-020084.
[AGENT][NEUTRAL] Oh, that's not ours. Mm, that's too many numbers.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And you said it was 14 line items. um, can you give me 1 or 2 out of those?
[CUSTOMER][NEUTRAL] Yeah, it is 36415847028470386900869018500785027.
[AGENT][NEUTRAL] OK, it's fine. Just, I just miss the I just I, I just needed a few of them. One moment.
[CUSTOMER][NEUTRAL] OK, OK, OK.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, uh, let's see.
[AGENT][NEUTRAL] 15. Yeah, it doesn't look like we have received that claim as of today.
[CUSTOMER][NEUTRAL] Oh, today.
[AGENT][NEUTRAL] Yeah, we have not received the claim as of today.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Oh, not received.
[AGENT][NEGATIVE] Yeah, not receipt.
[CUSTOMER][NEUTRAL] OK. So the bill amount $6,348 right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. OK. Can you please give the payer ID?
[AGENT][NEUTRAL] OK, for this one, the payer ID is one moment, um.
[AGENT][NEUTRAL] 845-556.
[CUSTOMER][NEUTRAL] 645-556.
[AGENT][POSITIVE] Mhm, yes, correct.
[CUSTOMER][NEUTRAL] OK. So upon checking here from our side on [PII], we have resubmitted a credit claim with the late charges, but you have stated you, didn't receive any claim, right?
[AGENT][NEUTRAL] Correct, the claim is not on file.
[CUSTOMER][NEUTRAL] OK. OK. May I know the contract claim family selling limit?
[AGENT][NEGATIVE] We don't have timely filing limits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, before moving to the next claim, may I know the call reference number for this one?
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in the state if you will, and let me go ahead and make a note and you don't have any other questions about this one?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, for this claim that's all from my side. I have another client.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] What is the next policy number?
[CUSTOMER][NEUTRAL] The next policy number is 02611071.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] The patient's name is uh uh [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] And what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Date of service is uh [PII] and the total charge amount was $1,058.20.
[AGENT][NEUTRAL] That was [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it looks like we processed that one on [PII] and we send a benefit amount of $50 which is the maximum payable amount under this policy for that date of service.
[CUSTOMER][NEUTRAL] OK, when is the claim receive the date?
[AGENT][NEUTRAL] OK, the claim received date is bear with me.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. Is there any uh patient responsibility?
[AGENT][NEUTRAL] OK, we are just a limited policy and we don't have any contractual involvement on the remaining of the claim, and that is the maximum payable under this policy, so it's up to the provider's discretion.
[CUSTOMER][POSITIVE] So the remaining balance is the providers right off.
[AGENT][NEUTRAL] It's the provider's discretion.
[CUSTOMER][NEUTRAL] Oh, OK. That is $1,008.20 right?
[AGENT][NEUTRAL] Yeah, the provider needs to make a decision on that. We cannot tell him what to do with the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. May I know the pay date?
[AGENT][NEUTRAL] The pay date is the same as the process date, which is [PII].
[CUSTOMER][NEUTRAL] [PII]. OK. May I have the claim number?
[AGENT][NEUTRAL] The claim number is.
[AGENT][NEUTRAL] 3602469.
[CUSTOMER][POSITIVE] Oh thank you so much.
[AGENT][NEUTRAL] There you go.
[CUSTOMER][NEUTRAL] So there is no patient responsibility. The remaining balance is provide us uh discount, right?
[AGENT][NEUTRAL] No, no. Again, we don't have any contractual involvement on the remaining of the claim, so we don't make that decision. That decision is made by the provider so they can go ahead and apply that towards whatever they need to apply it. We do not tell them what to do. So it's not a write off, it's not a discount, it's not a patient's responsibility, that's something that the provider needs to decide what to do with that balance, OK?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK. Can you please fax us the PDUB?
[AGENT][NEUTRAL] Sure, what is the fax number?
[CUSTOMER][NEUTRAL] It is [PII]. And attention to [PII].
[AGENT][NEUTRAL] OK, so that is uh fax number [PII]. Attention [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.