AccountId: 011433970860
ContactId: 7576ee19-20c0-4a34-a122-f67ac459723b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 301559 ms
Total Talk Time (AGENT): 152903 ms
Total Talk Time (CUSTOMER): 104858 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/7576ee19-20c0-4a34-a122-f67ac459723b_20250314T18:50_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon, thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. I'm sorry, what was your name?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Hi, so my name is [PII], calling from Borton Regional Hospital regarding a claim.
[CUSTOMER][NEUTRAL] And so what is the first initial your last?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII] and it's a direct line.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Sure, it's 60801.
[AGENT][NEUTRAL] Oh, that's the payer ID and the numbers in the bottom of that card where it says outpatient cert. Mhm.
[CUSTOMER][NEUTRAL] OK, um, I see it, I see it, I said, um, group number OK, hospital.
[CUSTOMER][NEUTRAL] Um, it's 025058.
[CUSTOMER][NEUTRAL] 94 ML 7.
[AGENT][POSITIVE] OK, perfect, thank you.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, perfect. Thank you. And may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Sure, date of service is [PII] through um just [PII] data service [PII] with a charge amount of 7,403 even.
[AGENT][NEUTRAL] OK, thank you. Let me see if I can find this claim for you. And again, that was [PII], correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Alright, let me pull this EOB. Let me see if this is yours.
[AGENT][NEUTRAL] And Miss [PII], I just need to let you know that for future you can check claim status online through our website at [PII] and that's just optional.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I wish it was that easy, sometimes it's just difficult to get the, find a member online and I would have saved that phone call.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I understand. Yeah, it's fine. That's what we're here for.
[AGENT][NEUTRAL] Alright, let's see 7403. Yes, this is it. OK, so it looks like we processed this claim on [PII] and we send a benefit amount of 1000 to the provider.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, when was it processed? I'm sorry. When did you receive it first of all? When did you receive it?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, let me see, let me get the receipt date that's not on the ELB one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright
[AGENT][NEUTRAL] OK, we received the claim on [PII], processed [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and we send a benefit amount of 1000, which 1000 is the maximum benefit per day for outpatient service.
[CUSTOMER][NEUTRAL] OK, um, it's a max amount is 1000 per day.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so the remainder will go towards patient responsibility because the deductible amount was for 4690.
[AGENT][NEUTRAL] Um, it's up to the provider's discretion, but more than likely that's what's gonna happen because it just goes back to the major medical and what they decided. Um, we're just a secondary, and we did pay the maximum.
[CUSTOMER][NEUTRAL] I know that
[CUSTOMER][NEUTRAL] Yeah, we just billed it as a secondary because we billed it to Blue Cross and we do receive the primary payment.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so is this a maximum benefit that that not allowed on this policy?
[AGENT][NEUTRAL] Yeah, anything, mhm.
[AGENT][NEUTRAL] For the date of service, yes, that is the maximum this policy pays per day. Mhm.
[CUSTOMER][NEUTRAL] OK, OK, and let me have the, um, do you have a check number by any chance?
[AGENT][NEUTRAL] I do, yes, I have a check number and a claim number if you need it. Um, the OK, the checking number is [PII]. Again, that's 2032269. The claim number is 3573981. Again, that's 3573981.
[CUSTOMER][POSITIVE] Go ahead please, yes.
[CUSTOMER][NEUTRAL] And where was the check mailed or issued?
[AGENT][NEUTRAL] On the same date of process, which it was [PII].
[CUSTOMER][POSITIVE] Got you. All right, thank you. you have a reference number for me?
[AGENT][NEUTRAL] Yeah. We don't. You can use my name in today's date if you will. Do you need the spelling of my name or any other information?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No thank you. I appreciate your help.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good afternoon. Happy week.
[CUSTOMER][NEUTRAL] Alright, you too, bye.
[AGENT][NEUTRAL] Mm.