AccountId: 011433970860
ContactId: 81893d9c-ce2c-474a-a9e2-14986de0432d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 547590 ms
Total Talk Time (AGENT): 185695 ms
Total Talk Time (CUSTOMER): 132817 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/81893d9c-ce2c-474a-a9e2-14986de0432d_20250207T20:39_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] Hello. So, I'm calling from provider office and I'm looking for the status of a claim.
[AGENT][NEUTRAL] OK, sure. I can assist you with claim status. May I have your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes. It is [PII].
[AGENT][NEUTRAL] OK. And where are you calling from, Mr. [PII]?
[CUSTOMER][NEUTRAL] I'm calling from Memorial Hospital of Carbon County.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It is 02567762.
[AGENT][NEUTRAL] OK. What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Patient's name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Date of service is [PII].
[CUSTOMER][NEUTRAL] And the bill amount is $319.
[AGENT][NEUTRAL] OK, [PII], the amount of $319 even, correct?
[CUSTOMER][NEUTRAL] Actually, there were two claims. So, second is $1,018.
[AGENT][NEUTRAL] 1018 for the same date of service.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] Alright, let me pull this explanation of benefits. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm still waiting on the system, one moment.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so it looks like we processed um both of the claims on [PII]. I'm gonna go ahead and give you the one for 319 1st and then I'll give you the information of the 1018, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so the $319 we can process on [PII], and we send a benefit amount of $50 and with the payment of that check, the maximum benefit for the date of service was met.
[CUSTOMER][NEUTRAL] How much paid? $50.
[AGENT][NEUTRAL] 50. Mhm.
[CUSTOMER][NEUTRAL] And the remaining amount?
[AGENT][NEUTRAL] It's up to the provider's discretion. Um, we don't have any contractual involvement on the remaining of the claim. This is a limited policy.
[CUSTOMER][NEUTRAL] So, is there any denial?
[AGENT][NEUTRAL] The denial with the check is um it says with this check, the maximum payable benefit for the date of service has been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, do you have a check number?
[AGENT][NEUTRAL] Yes, the check number is 2020187.
[CUSTOMER][NEUTRAL] 87.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK. Next claim.
[AGENT][NEUTRAL] OK, and the next claim for the 1018.
[AGENT][NEGATIVE] It was also processed [PII], and it was denied stating that the maximum benefit for the date of service has been met.
[CUSTOMER][NEUTRAL] There is no payment in this claim, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, processed on this.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, so do you have claim number?
[AGENT][NEUTRAL] Mhm, yes, let me get that for you on the phone.
[AGENT][NEUTRAL] OK, the claim number on this one is 3543322.
[CUSTOMER][NEUTRAL] And for a second.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, there is only one claim or two claims for.
[CUSTOMER][NEUTRAL] Separate claims.
[AGENT][NEUTRAL] That that's two separate claims. One is for the amount of $319. The second one is for the amount of $1,018.
[CUSTOMER][NEUTRAL] No. Do you have uh two claims number or only uh the both claims are under only this claim?
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] That is two separate claim numbers.
[CUSTOMER][NEUTRAL] Yes. What will be the 2nd?
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] OK, the one that we pay, let me give you that one again. The one we pay $50 the claim number on that one is 3,543,000. Again, this is the one that we process for the 319. Claim number is 3,543,000.
[AGENT][NEUTRAL] The one that we processed and denied was for $1,018 is 3543322.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] So it has been denied for maximum benefit for each.
[CUSTOMER][NEUTRAL] Uh, can you please, uh, tell me the, what's the maximum benefit in amount?
[AGENT][NEUTRAL] I'm sorry, I'm not understanding what you're asking.
[CUSTOMER][NEUTRAL] Uh, I'm asking that, what is the maximum benefit in dollar terms?
[AGENT][NEUTRAL] 0 $50.
[CUSTOMER][NEUTRAL] Uh, it is 40.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] For the date of service, it's $50 per date of service.
[CUSTOMER][NEUTRAL] A year
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'm done with this claim. May I have the call license number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] OK. Can you please spell your name?
[AGENT][NEUTRAL] That's [PII], last initial is [PII].
[CUSTOMER][POSITIVE] OK. Thank you so, for the information.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEGATIVE] No, no, no, thanks.
[AGENT][POSITIVE] Thank you for calling ATL. OK, have a good day. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye.