AccountId: 011433970860
ContactId: 7909973f-270a-4c61-8a6f-2dc8c5457368
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1441290 ms
Total Talk Time (AGENT): 274571 ms
Total Talk Time (CUSTOMER): 357339 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/18/7909973f-270a-4c61-8a6f-2dc8c5457368_20250418T18:13_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hello. I had a question on one particular patient.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have uh several dates of er I'm sorry, I have several dates of service pending for her.
[AGENT][NEUTRAL] OK, is it for a claim that you have sent in?
[CUSTOMER][NEUTRAL] Yes, several claims.
[AGENT][NEUTRAL] OK, OK, I can help you with claims. Can you please give me your name and your callback number just in case the call gets disconnected?
[CUSTOMER][NEUTRAL] Wonder
[CUSTOMER][NEUTRAL] Yes, my name is [PII]
[AGENT][NEUTRAL] OK, and then what is your callback?
[CUSTOMER][NEUTRAL] Uh, my callback number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] OK, her name is, first name is [PII]
[CUSTOMER][NEUTRAL] Last name, it's [PII] I'm sorry. Yes.
[CUSTOMER][NEUTRAL] Just like that.
[AGENT][NEUTRAL] OK. And her date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then also her policy number.
[CUSTOMER][NEUTRAL] Yes, that is 01869092.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][POSITIVE] Wonderful. Let me grab one paper. Give me one moment, OK? I'm not gonna place you on hold just give me one moment.
[AGENT][NEUTRAL] OK, yes, go ahead. No, that's fine, go ahead and take your time.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] OK, I'm here.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright, and what is the first day of service and the charge amount?
[CUSTOMER][NEUTRAL] OK, let me go from there.
[CUSTOMER][NEUTRAL] Oldest to the, you go from the oldest, let me go.
[CUSTOMER][POSITIVE] Sorry about that.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Just trying to
[CUSTOMER][NEUTRAL] I haven't been here in 5 months, so I'm trying to get myself back together here.
[AGENT][NEUTRAL] Oh my.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh my goodness, let me see.
[CUSTOMER][NEUTRAL] What happened here?
[CUSTOMER][NEUTRAL] You asked for the first date of service correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so that first date of service is going to be.
[CUSTOMER][NEUTRAL] Let's try [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then what's the charge amount?
[CUSTOMER][NEUTRAL] 1214
[CUSTOMER][NEUTRAL] That charge amount is
[CUSTOMER][NEUTRAL] $4,609.90.
[AGENT][NEUTRAL] OK, and then what are the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] OK, let me get that and I apologize my um.
[CUSTOMER][NEGATIVE] Let me get this logged back my computer locked out when you, when I was on the line with you, but it won't take me but one second.
[AGENT][NEGATIVE] Oh no.
[AGENT][NEUTRAL] OK, that's fine.
[CUSTOMER][NEUTRAL] Uh, it, it won't take me but one second to get back in.
[AGENT][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] I'm back in. I'm, I'm back in, I'm back in.
[CUSTOMER][NEUTRAL] It's just like what happened here?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so then after.
[CUSTOMER][NEUTRAL] That was, I'm sorry, what data service did I give you? I apologize.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, I shouldn't have started there, but let's go there. 12:14 is after.
[CUSTOMER][NEUTRAL] Pat, um, after the primary, that it was only gonna be a $40 payment, I mean a $40 patient responsibility.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK and then what is the name of the facility you're calling for?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Valley Retina Institute.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I look up this claim, Miss [PII] and I'll be right back with you.
[CUSTOMER][NEUTRAL] OK, and it's gonna be the same patient and I have a few days of service for her.
[AGENT][NEUTRAL] OK, what's the next date of service and I'll look them all up together.
[CUSTOMER][POSITIVE] Oh, OK, great, perfect.
[CUSTOMER][NEUTRAL] OK, so let me give all those to you so it's gonna be 8-27-2024.
[CUSTOMER][NEUTRAL] And the bill amount is $4,988.43.
[AGENT][NEUTRAL] And then after primary?
[CUSTOMER][NEUTRAL] $40.
[AGENT][NEUTRAL] OK, and then the next one?
[CUSTOMER][NEUTRAL] Uh, the next one is going to be.
[CUSTOMER][NEUTRAL] Day of service [PII].
[CUSTOMER][NEUTRAL] Billed amount is $1,458.72.
[CUSTOMER][NEUTRAL] And then after primary, oh wait, uh, we did have partial 5, we did get a partial payment. OK, so then I guess I have a question on that one because we did receive partial payment from your office.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] On this patient, but not.
[AGENT][NEUTRAL] All right, I'll look that one up and get the payment information.
[CUSTOMER][POSITIVE] Great.
[AGENT][NEUTRAL] And is there any more?
[CUSTOMER][POSITIVE] Yes, let me get you the next one.
[CUSTOMER][NEUTRAL] I gave you [PII]. No, I didn't. [PII] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And the charge amount?
[CUSTOMER][NEUTRAL] It's gonna be 4000.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] $4,609.90.
[CUSTOMER][NEUTRAL] And then after primary that's going to be patient responsibility of $40.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Then we had already done 1214.
[AGENT][NEUTRAL] And is this
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, and I've got 12:17. I'm sorry, yes, 12-172024.
[CUSTOMER][NEUTRAL] Uh, billed amount is $4,609.90. After primary insurance, that's gonna be a $40 patient responsibility.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then I'm assuming the others haven't been billed, which are 2025. I, I don't show that they've gone out so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK, all right. I'm gonna put you on a quick hold. I'm gonna look this up for you and I will be right back. You'll just have to give me a minute to do it because I'll have to search every one of them, OK? All right. OK, thank you.
[CUSTOMER][POSITIVE] Great.
[CUSTOMER][POSITIVE] Not a problem.
[CUSTOMER][POSITIVE] No, that is sweet. Thank you.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Uh huh. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 39
[AGENT][NEUTRAL] 2
[AGENT][NEUTRAL] 90
[AGENT][NEUTRAL] Paid
[AGENT][NEUTRAL] 7894.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] one
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Um
[AGENT][POSITIVE] OK, thank you for holding for me, Miss [PII].
[CUSTOMER][NEUTRAL] Of course, of course.
[AGENT][NEUTRAL] Alright, so let's first go to the one that was paid, um, it was the claim number 352-3917.
[AGENT][NEUTRAL] Paid 200.
[CUSTOMER][NEUTRAL] Uh, data service?
[AGENT][NEUTRAL] The 10:30.
[CUSTOMER][NEUTRAL] I'm sorry, I need the date.
[AGENT][NEUTRAL] The [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it was paid $278.94 and then after that payment it maxed out the benefit for the calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Stop benefits for calendar.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, what does that mean?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] That means that they used up their benefit for the calendar year so after their benefit is maxed out, then nothing is paid for the rest of the year.
[CUSTOMER][NEUTRAL] Oh, OK, so 1119.
[AGENT][NEUTRAL] Uh, they get
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So they get uh on this policy, they get an outpatient calendar year benefit that helps towards deductible, co-pay or co-insurance.
[AGENT][NEUTRAL] Of $2550 and that's just to verify benefits it's not a guarantee of payment. Um, once that $2550 has been used up, then there's nothing left to pay with because it's been used up and that's the case for every other.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Data service.
[AGENT][NEUTRAL] The calendar year benefit was maxed for the year.
[CUSTOMER][NEUTRAL] OK, so let me.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, so I think it was this one that had a part uh let me see, I know there was one that had a partial payment, no, not this 1, 1119.
[AGENT][NEGATIVE] That's the one that's the only one that was paid was the and it was paid $278.94. Once that $278.94 was paid, it used up the rest of the calendar year benefit so there was nothing left to pay anymore.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So that's patient responsibility. OK. So then.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] We don't give patient responsibility because we let the the providers determine that.
[CUSTOMER][NEUTRAL] Oh yeah, cause that went towards the deductible, the patient's uh primary deductible.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So they would have to be responsible for that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] But that's the case on every.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All the other dates of service, the calendar year, the claim was denied because the benefit for the calendar year had been maxed.
[CUSTOMER][NEUTRAL] OK, so how do I get those, uh, denials? I, I just need the denials for 1119, 1214, and 1217.
[AGENT][NEUTRAL] OK. 1119, 1214, and 1217. OK, let me put, can you give me your fax number?
[CUSTOMER][NEUTRAL] 7
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yes, can you do email or does it have to be fax?
[AGENT][NEGATIVE] It has to be by fax email is not secure.
[CUSTOMER][NEUTRAL] OK, that's
[CUSTOMER][NEUTRAL] OK, uh, that, that'll that'll be fine, um.
[CUSTOMER][NEUTRAL] Uh, the fax number, it's [PII].
[CUSTOMER][NEUTRAL] 683.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I get these faxes ready for you, and I'll be right back again, Miss [PII]. Thank you, ma'am.
[CUSTOMER][POSITIVE] Wonderful.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, Ms. [PII]. I have those faxes on their way to you now.
[CUSTOMER][NEUTRAL] 224222. OK, perfect. Now, on the other data service was 827-2024?
[AGENT][NEUTRAL] Uh, 8-27-2024, there was no claim on file for that date of service.
[CUSTOMER][NEUTRAL] OK, so I'll go ahead and what did I, let me see, [PII], correct. OK. OK, so I'll go ahead and get that sent in.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Along with the other two for [PII] and then I'll go ahead and look for those other uh denials in our um facts. I've got a great, I have great co-workers, they're gonna look for that out for me.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Awesome, good deal. OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][POSITIVE] Well, thank you so much for your time.
[AGENT][POSITIVE] Well, you're very welcome.
[CUSTOMER][POSITIVE] No, not at the moment. Have yourself a wonderful Easter.
[AGENT][POSITIVE] You too, Miss [PII], thank you. I appreciate that you have a blessed one also, and thank you for calling APL. You're welcome.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you appreciate it.
[CUSTOMER][POSITIVE] Thank you. Bye bye.
[AGENT][NEUTRAL] Bye-bye, ma'am.