AccountId: 011433970860
ContactId: 877e9131-e89a-41e4-a4af-4c68755d9111
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 991700 ms
Total Talk Time (AGENT): 338042 ms
Total Talk Time (CUSTOMER): 221799 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/877e9131-e89a-41e4-a4af-4c68755d9111_20250317T12:44_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] In one place.
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from provider office checking on claim status.
[AGENT][POSITIVE] Hi [PII], I'll be more than happy to help you with the claim status, and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Is [PII] is a direct line. There is no extension.
[AGENT][NEUTRAL] Thank you for that and also may I have a good contact, I'm sorry, may I have the member's policy number?
[CUSTOMER][NEUTRAL] It's going to be 1330836 S. 6 ML 8.
[AGENT][NEUTRAL] 1330836
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And all the information provided is a verification of benefits, not a guarantee of payment, and may I have the date of service for the claim you'd like me to check on?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And the total bills?
[CUSTOMER][NEUTRAL] It's going to be $3,252.75.
[AGENT][NEUTRAL] Thank you. And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Miss [PII].
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] Alright, so I'm showing that the claim was received on [PII]?
[AGENT][NEUTRAL] The claim number is 352.
[AGENT][NEUTRAL] 228 5.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And on [PII], the claim was denied?
[AGENT][NEUTRAL] And hold on one moment, I'm getting the reason for you now.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The outpatient benefit for the calendar year has been met.
[CUSTOMER][NEUTRAL] What is the allowed units for this patient?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] For outpatients, the benefit is $750 per calendar year. So by the time your claim came in to be processed, the $750 for the year has already been used.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Can I get a claim number one more time?
[AGENT][NEGATIVE] Unfortunately, no, that claim does not belong to you, but on the data service for your claim, the total um for the benefit had been used.
[CUSTOMER][NEUTRAL] OK. Could you please fax the UB for me?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] It's going to be
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And should I put attention, [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright, and that was [PII] attention [PII].
[CUSTOMER][NEUTRAL] OK. When will we receive the fax?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] At what time we received the fax after?
[AGENT][POSITIVE] Um, you have to give a fax at least an hour, um, to be received. If you haven't received it by the end of day today, you can definitely give us a call and we'll be more than happy to resend it for you.
[CUSTOMER][NEUTRAL] OK, enough. OK, and I came on to next one. I have a few more claims.
[AGENT][NEUTRAL] How many claims do you have in total?
[CUSTOMER][NEUTRAL] I have 5 claims.
[AGENT][NEUTRAL] OK, hold on one moment, let me note this claim and do you need the explanation of benefits for each claim we process we go over?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, would it be sent to this fax number? I'm asking because I'm gonna send them all at the end.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So will you need explanation of benefits for each claim sent to the fax number you gave?
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I know, I had to think.
[AGENT][NEUTRAL] I wanted to handle the call. I'm gonna do the notes after each one. So when it's over, you know, so when it's over.
[AGENT][NEUTRAL] All the notes will be done and I could just explanation. That's a good plan. [PII] call from number 4656203 claim status.
[AGENT][NEUTRAL] Uh 956.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. And what's the next member's policy number?
[CUSTOMER][NEUTRAL] It's going to be.
[CUSTOMER][NEUTRAL] 01846260 Mike Lima 8.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] It's going to be
[CUSTOMER][NEUTRAL] It's September 6 2024 $15,382.
[AGENT][NEUTRAL] September 6 2024 $15,382.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And would this be the same provider or a different provider for this claim?
[CUSTOMER][NEUTRAL] It's different provider only across hospitals?
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Alright, so I'm showing we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 352.
[AGENT][NEUTRAL] 6304.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim to the provider, a total of $249.75.
[AGENT][NEUTRAL] Did you need the checking information?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Uh, what is, what about the remaining balance?
[AGENT][NEUTRAL] If there's a remaining balance, it would be up to provider and primary to determine if it's patient responsibility or how the bill will be handled.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Uh, could you please fax to you for this one also.
[AGENT][NEUTRAL] Yes, we're faxing the EOB for all the claims we go over today.
[AGENT][NEUTRAL] Did you have another claim for this number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Alright, hold on one moment, let me note this policy and we can move on to the next one.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Alrighty, and the next member's policy number?
[CUSTOMER][NEUTRAL] It's going to be.
[CUSTOMER][NEUTRAL] 02413470.
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you for that and may I have the date of service for the claim and the total bills?
[CUSTOMER][NEUTRAL] [PII], total bill amount of $2180.
[AGENT][NEUTRAL] Thank you. And again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment, and hold on one moment while I locate this claim for you.
[AGENT][NEUTRAL] Alright, I'm showing, so for this one, is it the same, um same provider as the last one or would it be different?
[CUSTOMER][NEUTRAL] Sa provider Holy Cross Hospital for.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'm trying to received the claim on [PII].
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] The claim number is 354-835-8.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] And hold on one moment, because the outpatient benefit for the calendar year has been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can you on to the next one? Oh, what is the maximum allowed units for uh, allowed units for this patient?
[AGENT][NEUTRAL] Um, for the outpatient for the calendar year, it's $1250.
[CUSTOMER][NEUTRAL] $1250.
[CUSTOMER][NEUTRAL] Uh, it's uh calendar year is fully met, right?
[AGENT][NEUTRAL] Correct. By the time your claim came in, they had already used the balance.
[CUSTOMER][NEUTRAL] Can I move on to the last one?
[AGENT][NEUTRAL] Sure, I have to know each policy. Give me just a moment.
[AGENT][NEUTRAL] And the next member's policy number?
[CUSTOMER][NEUTRAL] 02370.
[CUSTOMER][NEUTRAL] 305 ML 8.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] All right, and the data of service and the total bill?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And the total bills?
[CUSTOMER][NEUTRAL] 2 $1,619.
[AGENT][NEUTRAL] And you said this is for [PII]?
[CUSTOMER][NEUTRAL] Early Cross Hospital, where's [PII].
[AGENT][NEUTRAL] The member's name?
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, yeah, same, [PII].
[AGENT][NEUTRAL] OK, the reason I'm asking is because there's no claim on file for [PII] or [PII] for her birthday.
[CUSTOMER][NEUTRAL] No claim on file.
[CUSTOMER][NEUTRAL] $1,619.
[AGENT][NEUTRAL] It's not the amount, it's the.
[CUSTOMER][NEUTRAL] Total charge amount.
[AGENT][NEUTRAL] Is the date when I put in the date or the date range, there's no claims that populate, so we don't have any claims on file. However, there is no time.
[CUSTOMER][NEUTRAL] OK. [PII].
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] OK. The patient effect on termination date.
[AGENT][NEUTRAL] Yes, so I was gonna let you know there's no timely filing limit and this member um policy has been active um since [PII] and it's still active, so you can file at any time.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII]. Get the claim mailing address.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] OK the payer ID?
[AGENT][NEUTRAL] 60
[AGENT][NEUTRAL] 801.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, how can you spell out your name?
[AGENT][NEUTRAL] Yes, my name is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm call reference.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date.
[CUSTOMER][POSITIVE] Thank you, [PII]. Thank you for assisting me. Bye-bye. Take care.
[AGENT][POSITIVE] You're welcome, [PII], and thanks for calling APL. Was there anything else I can help with?
[CUSTOMER][NEUTRAL] Well, nothing else.
[AGENT][POSITIVE] All right, well, I hope you have a great week and thanks for calling APL again. Bye-bye.
[CUSTOMER][NEUTRAL] You have.