AccountId: 011433970860
ContactId: 8f8e244f-fdd0-450f-8f95-8ed1f01516b9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 414980 ms
Total Talk Time (AGENT): 174792 ms
Total Talk Time (CUSTOMER): 167810 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/8f8e244f-fdd0-450f-8f95-8ed1f01516b9_20250116T16:09_UTC.wav
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[AGENT][NEUTRAL] For calling American Public Life, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII]. I'm calling from provider's office to check a claim status, please.
[AGENT][NEUTRAL] I can verify claim status. May I have a policy number?
[CUSTOMER][NEUTRAL] Yes, it's um 02510757 ML 8.
[AGENT][NEUTRAL] May I have a good callback number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Her name is [PII] [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. One moment.
[CUSTOMER][POSITIVE] Mhm thank you.
[AGENT][NEUTRAL] May I have the date of service?
[CUSTOMER][POSITIVE] Data service, yes, oh my gosh.
[CUSTOMER][NEUTRAL] It's for [PII].
[AGENT][NEUTRAL] In total bill amount?
[CUSTOMER][NEUTRAL] $950.
[AGENT][NEUTRAL] Thank you. For future reference, you may visit our website at [PII] to check claim status as well.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Looks like this processed under claim number 352-5888. It's like it processed on 11-5-2024. Looks like.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For procedures 76,830. The primary insured paid in full. And it looks like 76856. We are asking for a detailed EOB.
[CUSTOMER][NEUTRAL] OK, uh, I have a question because I, when we submit the claim by fax, we sent, um, 3 pages on the, on the second page it's like patient responsibility $80 and the third page it's like um the description it's the you'll be actually from Ahmed and there's um you see like plan paid $193 with 2 cents and you may owe $80.
[CUSTOMER][NEUTRAL] So it
[CUSTOMER][NEUTRAL] You know, I don't know if you need, you guys need like more information, but
[AGENT][NEUTRAL] OK. I'm just waiting on the claim image to load.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] I do apologize. Our system is slow.
[CUSTOMER][NEUTRAL] It's OK.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] Total bill is $950. Patient responsibility is $80.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So I guess they are looking to see what was applied to the co-pays, the co-insurance, and our deductibles. Let me see.
[AGENT][NEUTRAL] Go back over to the next page.
[AGENT][NEUTRAL] Because it only states plan paid total amount, amount you may owe.
[CUSTOMER][NEUTRAL] Mhm. I think that that.
[AGENT][POSITIVE] But it doesn't give any type of colds.
[CUSTOMER][NEUTRAL] OK, the, the thing is that that's um the only EOV that Ahmed provides, so.
[AGENT][NEUTRAL] On the first page.
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][NEUTRAL] Where it says amount billed plan allowed plan pay, patient responsibility, is there anything that states copays, coinsured, and our deductibles?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, it's just like, that's the OB from Ahmed, that's the only thing, so.
[CUSTOMER][NEUTRAL] You know, it's a little bit difficult. And at this point, to be honest, I don't know if, you know,
[CUSTOMER][NEGATIVE] It's just, it's like um we need to charge the patient because you guys are not, you know.
[CUSTOMER][NEUTRAL] Covering this amount.
[AGENT][NEUTRAL] Yeah, and it looks like that's, that's what they're trying to determine whether it would be a co-pay, a co-insurance, and or a deductible. cause sometimes if the primary insurance does not pick up and it becomes patient's responsibility, if it's not applied to the co-pay, not applied to the co-insurance, not applied to the deductible, this plan will not pick it up.
[CUSTOMER][NEUTRAL] OK, let me see because I'm, I'm looking on her eligibility to see her benefits.
[CUSTOMER][NEUTRAL] But I don't know if you guys can check like if I can send you uh oh yes, it's it's a copy specialist visit in network you will pay the list.
[CUSTOMER][NEUTRAL] Yeah, so for PCP it's $40 especially it's it's um $80 copay.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So do you think I can um fax this?
[AGENT][POSITIVE] Yes, I would. Anything that could help, I would fax over.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] Yeah, mhm. It's a specialist is.
[CUSTOMER][NEUTRAL] Uh, specialist copayment, $80.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect. OK, so I'm gonna
[AGENT][NEUTRAL] And then just reference that claim number 352-588-8 and you can fax it over to [PII] attention claims.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, it's [PII] extension claims.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, perfect. Can I have your name and a call reference number, please?
[AGENT][NEUTRAL] Yes, it will be [PII] Last initial is [PII] along with today's date. And can you spell your first name for me, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, it's [PII]
[AGENT][POSITIVE] [PII], thank you so much. Is there anything else I can assist you with?
[CUSTOMER][POSITIVE] Thank you. No, thank you so much for your help.
[AGENT][POSITIVE] No, you're so welcome. And thank you for calling American Public Life. Have a great day. Bye-bye.
[CUSTOMER][POSITIVE] You too. Bye, thank you.