AccountId: 011433970860
ContactId: 7edc1fbe-fec8-477e-952e-ee4352f0bb55
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 712909 ms
Total Talk Time (AGENT): 221628 ms
Total Talk Time (CUSTOMER): 226572 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/7edc1fbe-fec8-477e-952e-ee4352f0bb55_20250314T19:00_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah, you can assist me that we uh.
[CUSTOMER][NEUTRAL] Actually, my name is [PII] calling from the provider office regarding claim status.
[AGENT][NEUTRAL] OK, I can assist you with claim status. I didn't get your name and you're a little bit too loud on the phone. I don't know if you're just too close to the microphone.
[CUSTOMER][NEUTRAL] Yeah, it's Avi. It's Avi, A for Alpha, V for Victor, I for India, and initial is B, B for boy.
[AGENT][NEUTRAL] OK, one moment, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] May I have a callback number just in case we get disconnected Mr. [PII].
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] OK. And you're calling from which facility for my notation?
[CUSTOMER][NEUTRAL] Uh, Holy Cross Hospital.
[AGENT][NEUTRAL] OK, and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It's 0228617 M for Mike, L for Lima, 8.
[AGENT][NEUTRAL] Can you repeat that number one more time.
[CUSTOMER][NEUTRAL] Sure. 0228617 ML.
[CUSTOMER][NEUTRAL] M for Mike, L for Lima, 8.
[AGENT][NEUTRAL] Yeah, we're missing a digit. Do you have the copy of the card?
[CUSTOMER][NEUTRAL] Which uh which copy?
[AGENT][NEUTRAL] A copy of the card?
[AGENT][NEUTRAL] Because we're missing a day.
[CUSTOMER][NEUTRAL] Insurance card, right?
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] You're asking about the insurance card, right?
[AGENT][NEUTRAL] Yes, uh-huh.
[CUSTOMER][NEUTRAL] Yeah, already is there.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Yeah, I need a claim status for this number.
[AGENT][NEUTRAL] I do understand that Mr. [PII]. I need a I need a policy number that is complete. It's missing a digit. So do you have the copy of the card so I can get the complete number?
[AGENT][NEGATIVE] The policy number you're giving me is missing one digit.
[CUSTOMER][NEUTRAL] So, can you repeat again, please, uh, check it once.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] 0, I can repeat again. Please uh check it once. 0228617 M for Mike, L for Lima, and 8.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] OK, that's what I have. It's missing a digit.
[AGENT][NEUTRAL] It's supposed to be after the 07 digits. You're giving me 6228617. That's 6 digits. It's supposed to be seven digits after the 0.
[AGENT][NEUTRAL] So if you have a copy of the card, you'll be able to see the whole number. Do you have a copy of the card?
[CUSTOMER][NEUTRAL] Yeah. Give me a moment. I want to check it once.
[AGENT][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] OK. Uh, and the copy, uh, shows only coverage and group number affected date and the plan.
[AGENT][NEUTRAL] OK, in the bottom, outpatients start.
[CUSTOMER][NEUTRAL] That's it if there is no policy number.
[AGENT][NEUTRAL] In the bottom, give me the numbers in the bottom that it says outpatient search.
[CUSTOMER][NEUTRAL] OK, in the bottom, we don't have any details.
[AGENT][NEUTRAL] What's the group number?
[CUSTOMER][NEUTRAL] Nope. Is there any, no.
[CUSTOMER][NEUTRAL] The group number is 17433.
[AGENT][NEUTRAL] OK, it's gonna be a minute. I have to pull the whole group. OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's the last name of the patient?
[CUSTOMER][NEUTRAL] Yeah, it's patient's last name, uh.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] First name is [PII]
[AGENT][NEUTRAL] What's the date of birth?
[CUSTOMER][NEUTRAL] So [PII].
[AGENT][NEUTRAL] OK. What's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] The date of [PII].
[CUSTOMER][NEUTRAL] And the bill amount uh $10,281 even.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so it looks like we have processed the claim on [PII].
[CUSTOMER][NEUTRAL] Just hold on.
[AGENT][NEUTRAL] Mhm. Mhm.
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] What was the name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm. The received date was on [PII].
[CUSTOMER][NEUTRAL] OK. What was the claim status?
[AGENT][NEUTRAL] We have processed the claim. We have sent a payment of $822.37.
[CUSTOMER][NEUTRAL] OK, the claim has been paid, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. What is the pay date?
[AGENT][NEUTRAL] The same day as the process date.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] In the process that with the.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah, I want to pay the amount.
[AGENT][NEUTRAL] 822, 37 cents.
[CUSTOMER][NEUTRAL] No, and your PMC is not coming. 8.
[CUSTOMER][NEUTRAL] 22 and 37 cents.
[AGENT][NEUTRAL] $822.37.
[CUSTOMER][NEUTRAL] What is the added amount?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, I'm asking about allowed amount.
[AGENT][NEUTRAL] We're not the major medical. We're the secondary.
[CUSTOMER][NEUTRAL] OK. Uh, so, actually, the primary is uh United Healthcare. The bill amount is $10,281 and they paid 36.
[CUSTOMER][NEUTRAL] 25 cents and I just said $9,365 even.
[CUSTOMER][NEUTRAL] And uh crossover to secondary and the $879.75 to secondary American Public Health.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] But you paid only $822.37. What was the balance remaining amount? It's the $57.38.
[AGENT][NEUTRAL] It looks like it is, yes, um, we paid a 22 to 37 because with the payment of that check, the benefit has been exhausted.
[CUSTOMER][NEUTRAL] OK. Benefit has been exhausted.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. Give me a moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, claim, uh, claim has, you said the claim has denied, right?
[AGENT][NEUTRAL] The claim has paid $1822.37.
[CUSTOMER][NEGATIVE] Uh but the remaining 4757 and 38 cents are not paid. So the maxim has been exhausted. What was the denial date?
[AGENT][NEUTRAL] The same as the process date, [PII].
[CUSTOMER][NEUTRAL] Same has been processed it.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. May I, may I know maximum benefit is in terms of dollars I visit?
[AGENT][POSITIVE] Dollar value.
[CUSTOMER][NEUTRAL] Dollars
[CUSTOMER][NEUTRAL] In Denmark dollars. How, OK. How much dollars amount is allowed?
[AGENT][NEUTRAL] OK, for outpatient service, and this is not a guarantee of payment, just a verification of coverage. There is a calendar day, a daily benefit of 1000.
[CUSTOMER][NEUTRAL] Yeah, uh, could you repeat again slowly?
[AGENT][NEUTRAL] Outpatient benefit is 1000 per day.
[CUSTOMER][NEUTRAL] OK. Patient benefit has been 1000 per day.
[AGENT][NEUTRAL] Outpatient benefit is 1000 per day.
[CUSTOMER][NEUTRAL] $1000 per day.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. How how much dollars amount has patient made in uh excluding this claim?
[AGENT][NEUTRAL] With the 822 37, she has exhausted the benefit of 1000.
[CUSTOMER][NEUTRAL] OK, but uh
[CUSTOMER][NEUTRAL] But remaining is there
[CUSTOMER][NEUTRAL] You said that $1000 right, for a day?
[CUSTOMER][NEUTRAL] But I just only to uh I don't.
[AGENT][NEUTRAL] She has, she has. OK. Mr. Ay, she has $1000 per day, OK, for any claims we received for that day, OK. We received claims before this claim. We pay those claims and she had only $822.37 when we received your claim. So we send the $822.37 and that completed the whole $1000.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So she already exhausted the benefit with the one with the 2237.
[CUSTOMER][NEUTRAL] OK, hold on.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So what's your name?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Uh yes. Mhm.
[CUSTOMER][NEUTRAL] I'm asking your name.
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] Can you spell it?
[CUSTOMER][NEUTRAL] Can you spell it?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] What is the call reference number?
[AGENT][NEUTRAL] We don't have reference number so you can use my name in today's name.
[CUSTOMER][POSITIVE] OK. So thank you for giving this information.
[AGENT][NEUTRAL] You're welcome, Mr. [PII]. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] Yeah. Nothing else completed.
[AGENT][NEUTRAL] OK, thank you for calling APR. bye bye.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Bye bye.