AccountId: 011433970860
ContactId: 853910fe-a18b-4357-a232-a3d04da61336
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 549000 ms
Total Talk Time (AGENT): 209041 ms
Total Talk Time (CUSTOMER): 125496 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/853910fe-a18b-4357-a232-a3d04da61336_20250219T17:51_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and my last initial is [PII]. So I just want to know the claim status.
[AGENT][POSITIVE] It would be my pleasure to assist you. Do you mind spelling your first name as well?
[CUSTOMER][NEUTRAL] Sure. That is [PII].
[AGENT][POSITIVE] Thank you [PII]. And what is a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Uh, my callback number is [PII].
[AGENT][NEUTRAL] Thank [PII], what is the patient's policy number please, ma'am?
[CUSTOMER][NEUTRAL] Sure. The policy number is 02567762.
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Patient first is [PII], and the last name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth for this patient is [PII].
[AGENT][POSITIVE] Alright, thank you, and it would be my pleasure to assist you with claim status today [PII]. What is the data service?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] And what is the bill amount please ma'am?
[CUSTOMER][NEUTRAL] That is $1,018.
[AGENT][NEUTRAL] And what is the facility name?
[CUSTOMER][NEUTRAL] Memorial Hospital of Carbon County.
[AGENT][NEUTRAL] Thank you. I can help you with that claim status. We received this claim on [PII].
[AGENT][NEUTRAL] And processed on [PII].
[AGENT][NEUTRAL] And the claim was denied because the maximum benefit for that date of service has been met.
[CUSTOMER][NEUTRAL] When it was denied?
[AGENT][NEUTRAL] On [PII]?
[CUSTOMER][NEUTRAL] OK. What is the claim number?
[AGENT][NEUTRAL] The claim number is 354.
[AGENT][NEUTRAL] 3322.
[CUSTOMER][NEUTRAL] And which if it is denied due to maximum benefit reach?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] With CT?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] This is for an emergency room built on a UBO4. There's no list of CPTs it's for the total amount that was denied.
[CUSTOMER][NEUTRAL] Uh, OK. So,
[CUSTOMER][NEUTRAL] I see I'm checking there are 3 CPT codes found on this claim 850258005399283. So which is it?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] All CPTs are denied as maximum benefit met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you. And I have one more claim for the same date of service and the billing amount is $319.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And that claim we did receive.
[AGENT][NEUTRAL] On [PII] and processed on [PII].
[AGENT][NEUTRAL] And it was we did pay the maximum benefit payable for that data service on that CPT 99284.
[CUSTOMER][NEUTRAL] Hi, this is [PII].
[AGENT][NEUTRAL] It was paid the maximum benefit payable we received this claim prior to the other claim and we paid the maximum benefit payable on this claim.
[CUSTOMER][NEUTRAL] So, there is no denial on this claim?
[AGENT][NEUTRAL] That's correct. We pay the maximum benefit of $50 for that data service.
[CUSTOMER][NEUTRAL] OK. So, can you please do one favor? Can you please fax me the EOB for the both claims?
[AGENT][NEUTRAL] EOBs are obtainable on a provider portal at [PII].
[AGENT][NEUTRAL] [PII]. It is a simple self-registration.
[CUSTOMER][NEUTRAL] You can't
[CUSTOMER][NEUTRAL] Actually, I need a fax. Can you please fax me? Is it helpful for me?
[AGENT][NEUTRAL] I can do that for you if you'll hold just one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] It'll take me just a moment, so bear with me, OK? And then I'll get that fax number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Can I put it, the
[AGENT][NEUTRAL] EOVs to your attention.
[CUSTOMER][NEUTRAL] Uh, I don't have an extension. It is a direct line.
[AGENT][NEUTRAL] Can I put your name as an attention [PII] for these claims?
[CUSTOMER][POSITIVE] Yes. Yes, yes.
[AGENT][NEUTRAL] Alright, bear with me just a minute and I'll be back to get the fax number for the first claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the fax number [PII]?
[CUSTOMER][NEUTRAL] Sure. My fax number is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, that first claim EOB is on the way if you'll bear with me just one moment, I'll get this other one on the way for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if y'all have get access to the website you'll have ins instant access to EOBs claim status, and you can submit claims online as well and that is that secured.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII] for future reference.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Just one more moment while I finish this request.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] Alright [PII], both of those EOBs are on the way for you. You should be receiving both of those shortly.
[CUSTOMER][NEUTRAL] OK, thank you. And uh can you please spell out your name and the reference number?
[AGENT][NEUTRAL] Mhm. My name is [PII]
[AGENT][NEUTRAL] First initial and my last name is [PII].
[AGENT][POSITIVE] And it has been a pleasure to assist you with that claim status. Is there anything else? Reference number is my reference number is my name and today's date.
[CUSTOMER][NEUTRAL] Reference number?
[CUSTOMER][NEUTRAL] Reference number.
[CUSTOMER][POSITIVE] Thank you, [PII]. Have a nice day.
[AGENT][NEUTRAL] I hope