AccountId: 011433970860
ContactId: 7f1b0328-1fed-445b-9f8a-dd61ef5c5295
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 971099 ms
Total Talk Time (AGENT): 207123 ms
Total Talk Time (CUSTOMER): 264782 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/7f1b0328-1fed-445b-9f8a-dd61ef5c5295_20250213T21:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from the provider's office to get the game status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. What is your callback number?
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So, um, that is going to be, uh, yeah, that's going to be [PII].
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] That's the one.
[AGENT][NEUTRAL] All right. And [PII], what's the insured's name?
[CUSTOMER][NEUTRAL] Just give me one moment. I'm just
[CUSTOMER][NEUTRAL] Taking the account.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. Before um going to the call, may I know the full spelling of your name and the last initial also, please?
[AGENT][NEUTRAL] Yes, it's [PII] and the last initial is [PII]
[CUSTOMER][NEUTRAL] Thank you, sir. So, um, you ask the patient's date of birth? Sorry?
[AGENT][NEUTRAL] No, I asked the patient's name.
[CUSTOMER][NEUTRAL] Sure. Um, the patient's name is [PII].
[AGENT][NEUTRAL] [PII], great. OK. And then what is?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. And then what is the patient's date of birth?
[CUSTOMER][NEUTRAL] Sure. So that's going to be [PII].
[CUSTOMER][NEUTRAL] Of [PII].
[AGENT][NEUTRAL] Thank you. And then um the patient's policy number?
[CUSTOMER][NEUTRAL] Sure, I'm uh.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] That is
[CUSTOMER][NEUTRAL] OK, so that's going to be 024.
[CUSTOMER][NEUTRAL] 350
[CUSTOMER][NEUTRAL] 30.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, let's see. Now we have that patient under [PII].
[AGENT][NEUTRAL] Is [PII] maybe the middle name?
[CUSTOMER][NEUTRAL] Sorry, sorry, [PII], what's that?
[AGENT][NEUTRAL] We have this patient's name as [PII].
[CUSTOMER][NEUTRAL] Oh, sorry, yeah, the legal name is [PII], correct? So I have, I have a, yeah, correct.
[AGENT][NEUTRAL] OK. OK, well.
[CUSTOMER][NEUTRAL] I just saw that, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What is the data of service for this patient?
[CUSTOMER][NEUTRAL] Sure. That's going to be.
[CUSTOMER][NEUTRAL] Um, yeah, so that's going to be, um, [PII].
[AGENT][NEUTRAL] OK, and the charge amount?
[CUSTOMER][NEUTRAL] Sure, so I would like to check on it.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh, see a moment, OK.
[AGENT][POSITIVE] Yes, sir. Go ahead and take your time.
[CUSTOMER][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] I have different amounts here. Just wanted to check.
[CUSTOMER][NEUTRAL] Do you have, oh my God, just, just give me uh one moment, sorry, OK.
[AGENT][NEUTRAL] Yes sir, go ahead.
[CUSTOMER][NEUTRAL] Um, yes, sorry. So, um, the total bill amount is going to be $413 even.
[AGENT][NEUTRAL] 40,430,430.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um, no, that's 413.
[AGENT][NEUTRAL] 413413. OK, thank you sir and then what is the amount after primary paid their part?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] All right, so, uh,
[CUSTOMER][NEUTRAL] I have an EOB of primary. I would like to check that out, sir.
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][POSITIVE] A proper explanation.
[CUSTOMER][NEUTRAL] So I can see.
[CUSTOMER][NEUTRAL] Anthem Held Keepers.
[CUSTOMER][NEUTRAL] have paid $77.64 and having a patient responsibility of $71.97. So which is
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] $55 as a co-pay and uh
[CUSTOMER][NEUTRAL] And uh $16 I'm sorry, $16.97 as deductible.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, this is what we got from the
[CUSTOMER][NEUTRAL] You know, um, the primary.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and then what is the name of the facility you're calling for [PII]?
[CUSTOMER][NEUTRAL] Sure, sir, but that's going to be [PII].
[AGENT][NEUTRAL] OK, what was that first name again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, thank you [PII]. I'm gonna put you on a brief hold while I look up this claim for you and I'll be right back.
[CUSTOMER][POSITIVE] Take your time, please.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK [PII] looking uh at data service of [PII], I do not find a claim on file for [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so, um,
[CUSTOMER][NEUTRAL] All right. So, um, can, can you please check with a data service, um, [PII].
[AGENT][NEUTRAL] OK, and what is the charge amount?
[CUSTOMER][NEUTRAL] Sure. Give me one moment.
[CUSTOMER][NEUTRAL] It's loading, just give me a moment, OK.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Um, yeah, so that is going to be $413 again.
[CUSTOMER][NEUTRAL] 413.
[AGENT][NEUTRAL] OK, 413.
[AGENT][NEUTRAL] And then what is the charge amount after the primary paid their part?
[CUSTOMER][NEUTRAL] Um, OK, I'd like to check that out, sir.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] I have the primary information.
[CUSTOMER][NEUTRAL] Um, that's going to be the same amount, which is $71.97 and which is, you know, applied for um Telpay and deductible again.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Thank you. And then is it for the same facility?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I look this one up for you and I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII], this is [PII] back with you. So looking on data service of [PII], I do not find a claim on file for that data service either.
[CUSTOMER][NEUTRAL] OK. So, um, I have, um, 3 other data services for the same patient also. So, uh, the next data service is um [PII].
[CUSTOMER][NEUTRAL] May I give all, all the details of which I have?
[AGENT][NEUTRAL] The all all of the data services and the charge amount?
[CUSTOMER][NEUTRAL] I have um
[CUSTOMER][NEUTRAL] Yes, I have another 3.
[AGENT][NEUTRAL] OK, so we got [PII], and what is the charge amount?
[CUSTOMER][NEUTRAL] That is $420 even.
[AGENT][NEUTRAL] And then after primary?
[CUSTOMER][NEUTRAL] Um, the same one.
[AGENT][NEUTRAL] 7197.
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK, and then what's the next date of service?
[CUSTOMER][NEUTRAL] That is going to be uh [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and charge amount?
[CUSTOMER][NEUTRAL] $749 even.
[AGENT][NEUTRAL] And then after primary?
[CUSTOMER][NEUTRAL] That is $176.14. 14.
[AGENT][NEUTRAL] OK, thank you and then what is the next date of service?
[CUSTOMER][NEUTRAL] That's going to be uh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and the charge amount?
[CUSTOMER][NEUTRAL] That's going to be uh
[CUSTOMER][NEUTRAL] $413 even.
[AGENT][NEUTRAL] OK, and uh after primary?
[CUSTOMER][NEUTRAL] That's um 797.
[CUSTOMER][NEUTRAL] The same
[AGENT][NEUTRAL] Thank you. And then do you have another data service?
[CUSTOMER][NEUTRAL] Uh, no, that's about all, you know, the data shows we have today.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, alright, I'm gonna put you on hold. I'm gonna look up all these dates of service for you and I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] All right, [PII], this is [PII] back with you, so.
[AGENT][NEUTRAL] None of those claims are on file either.
[CUSTOMER][NEUTRAL] Yes, sorry.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Um, may I have the mailing address?
[AGENT][NEUTRAL] Yes, sir. It's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's in [PII], [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We also have a payer ID number if you want to send them electronically.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Oh yes, that's 60801.
[CUSTOMER][NEUTRAL] Yeah, OK, so, uh, what's the, um, timely flying limit?
[AGENT][NEUTRAL] We don't have one as long as the policy was active on the date of service you can file at any time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, [PII]. So, uh, I think that's all about the claims today for you. So, um thank you for assisting me.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] You have
[CUSTOMER][NEUTRAL] Yeah. And before that, yeah, um, I need the call reference number also.
[AGENT][NEUTRAL] You can use my name and today's date.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Um, you have a good rest of day.
[AGENT][NEUTRAL] OK, [PII].
[AGENT][POSITIVE] You too [PII] thank you and you have a happy [PII] and thanks for calling APL.
[CUSTOMER][POSITIVE] Happy [PII]. Bye.
[AGENT][NEUTRAL] Bye-bye.