AccountId: 011433970860
ContactId: 904bbe99-b6fc-49a7-b2ab-574cffa1762d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 875830 ms
Total Talk Time (AGENT): 302645 ms
Total Talk Time (CUSTOMER): 235854 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/904bbe99-b6fc-49a7-b2ab-574cffa1762d_20250122T16:01_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, this is actually I'm calling from an agent's office and I just needed to check on a few claims to see if they were even filed.
[AGENT][NEUTRAL] OK, Ms. [PII], I can help you uh with the claims. um, can you please give me the group number that you're calling for?
[CUSTOMER][NEUTRAL] Sure it's 13715.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what's the agent's office that you're calling for?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And is there any way that you can verify the physical address for Triple B construction and fences for verification reasons or even [PII]'s um email address?
[CUSTOMER][NEUTRAL] Well, let me grab it.
[CUSTOMER][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] OK, yeah, [PII]'s email is [PII].
[AGENT][NEUTRAL] OK, thank you. I appreciate you verifying that for me. OK, Ms. [PII], what is the first and last name of the first claim?
[AGENT][NEUTRAL] Uh, insured that you need to look up.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK, it's [PII]
[AGENT][NEUTRAL] OK, and then what is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And her policy number?
[CUSTOMER][NEUTRAL] 02180309
[AGENT][NEUTRAL] OK, let me pull up [PII] real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK and then what is the date of service or the day that the um claim was reported on?
[CUSTOMER][NEUTRAL] OK, the first one is [PII].
[AGENT][NEUTRAL] And do you know the charge amount?
[CUSTOMER][NEUTRAL] Yes, it was $14,963.
[AGENT][NEUTRAL] OK, and do you happen to have the charge after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] But yeah.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] That's 317 44, but that included a member payment, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. Let me look real quick to see if I can find anything for this real quick for you on [PII].
[CUSTOMER][NEUTRAL] OK. Yeah, and it would be from surgical Specialty Center at Baton Rouge.
[CUSTOMER][NEUTRAL] After primary it looks like it would have been $567.44.
[AGENT][POSITIVE] OK thank you I appreciate you giving me that.
[AGENT][POSITIVE] OK, I believe I have found it and it has a remark on it.
[AGENT][NEUTRAL] OK, so this is the remark um we need a detailed EOB it states that we have received the primary explanation of benefits that was submitted with your claim. However, the explanation of benefits received does not list the amounts applied to the deductible, co-pay or co-insurance. Please submit a more detailed explanation of benefits that shows these amounts for further consideration of your claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got it. It doesn't apply to exact the copay.
[CUSTOMER][NEUTRAL] OK and um can you give me y'all's claim number to reference when I send this in?
[AGENT][NEUTRAL] Yes, ma'am. It's 337.
[AGENT][NEUTRAL] 6958.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it. And just to make sure, did she even have any of her outpatient benefit remaining for [PII]?
[AGENT][NEUTRAL] No
[AGENT][NEUTRAL] Oh, let's look
[CUSTOMER][NEUTRAL] I just thought about that.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me look.
[AGENT][NEUTRAL] OK, for [PII].
[AGENT][NEUTRAL] Looks like she used $5000 for her outpatient. Let me see on her.
[AGENT][POSITIVE] Benefits to see what her max is.
[CUSTOMER][NEUTRAL] I think that's all she had.
[AGENT][NEUTRAL] Yeah, she used it for 2023.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I figured that right, so she just needs to pay that and then I have another claim for her.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's see, this date of service was [PII].
[CUSTOMER][NEUTRAL] Total bill amount?
[CUSTOMER][NEUTRAL] It was $450,080.75 and then after primary it was like $3230.
[AGENT][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] OK, and is it for the same facility?
[CUSTOMER][NEUTRAL] No, this is actually Our Lady of the Lake Regional Medical Center.
[AGENT][NEUTRAL] OK, alright, let me look that one up real quick.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] He has a lot of surgeries if you can't tell us.
[AGENT][POSITIVE] Oh yeah, that's, yeah, bless your heart.
[AGENT][POSITIVE] That's a lot of recovery too.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 18
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Looks like this one was paid $20.32 with check number 1858779.
[AGENT][NEUTRAL] Let me look at the remarks to see why the amount was only 2032.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Says with the payment of this check, the policy maximum for this benefit has been met.
[CUSTOMER][POSITIVE] That's what I figured. All right.
[AGENT][NEUTRAL] OK, so let me.
[AGENT][NEUTRAL] Let me make sure that the check was cleared.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Yes, ma'am. The check was cleared from Our Lady of the Lake.
[CUSTOMER][NEUTRAL] OK, and that
[CUSTOMER][NEUTRAL] That makes sense cause I was coming up with about a $20 difference. OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me see, and then the last claim I have is for a different number.
[AGENT][NEUTRAL] A different member? OK, what's that member's name and policy number?
[CUSTOMER][NEUTRAL] Yes, different group.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] you
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] And that we're all boys and one down here, so.
[AGENT][NEUTRAL] I know we're, I'm in [PII], so I feel you girl, although you guys got way more than we did.
[CUSTOMER][NEGATIVE] Gotcha.
[CUSTOMER][NEUTRAL] So yeah, we got like probably about 8 or 9 inches of snow at my house.
[AGENT][POSITIVE] Oh my gosh.
[AGENT][POSITIVE] Oh my gosh.
[CUSTOMER][MIXED] It was beautiful, but it can go now.
[AGENT][NEUTRAL] Yeah, see, I grew up in [PII], so my opinion of snow is I like it when I go to visit it. I don't like it when it comes to me.
[AGENT][NEGATIVE] It's just such a mess.
[CUSTOMER][POSITIVE] Absolutely.
[AGENT][NEUTRAL] And so much work when you have to shovel everything.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] Absolutely. mm it's not for me.
[AGENT][POSITIVE] But it is pretty.
[CUSTOMER][POSITIVE] That it is. My dog liked it. That was fun. Now back to the norm.
[CUSTOMER][POSITIVE] OK. So my next person, uh, what did you need? I'm so sorry.
[AGENT][NEUTRAL] The name, the name of the insured?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Or the
[AGENT][NEUTRAL] [PII]. And she's also the patient, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then her date, uh, I'm sorry, her policy number?
[CUSTOMER][NEUTRAL] 1912984
[AGENT][NEUTRAL] OK, thank you. And then what is her date of service?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] From Acadian Ambulance Services.
[AGENT][NEUTRAL] OK, and do you know the charge amounts?
[CUSTOMER][NEUTRAL] $3,294.80.
[AGENT][NEUTRAL] OK, let me see if I can find her. Let me put my note in this one first.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's gonna be just a second while it tries to pull it up for me.
[CUSTOMER][NEUTRAL] Or take your time.
[AGENT][NEUTRAL] OK, I'm not seeing um for Acadian Ambulance Services. I do have a different amount but it's for Saint Bernard Parish Hospital.
[CUSTOMER][NEUTRAL] OK, got it. Um, and
[CUSTOMER][NEUTRAL] Can you tell me how much she had remaining of her 2024 outpatient benefit?
[AGENT][NEUTRAL] OK, let me look back and see.
[CUSTOMER][NEUTRAL] Before I even fight with the ambulance service.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, so she used for outpatient.
[AGENT][NEUTRAL] $25.42.
[AGENT][NEUTRAL] She has OTR. Let me see what that is on her benefits that she paid that was paid $940.80 and her deductible was taken out for $100. Let me see what the OTR.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's all that was used for her for 2024.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Office treatment writer.
[AGENT][NEUTRAL] So her office treatment was, was for that.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] All right. I think that's all that I had at the moment.
[AGENT][POSITIVE] OK, alright, well, if you figure out if you need any more help, please pick up the phone and call us, you know, we'll help you all we can.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Are you still there?
[CUSTOMER][NEUTRAL] Sorry, can you hear me?
[AGENT][POSITIVE] Yeah, now I can.
[CUSTOMER][POSITIVE] OK, OK, yeah, well, I said I certainly appreciate all of your help and I'll call back if anybody else pops up.
[AGENT][POSITIVE] OK. Thank you so much, [PII]. Try to stay warm.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][POSITIVE] You take care. Bye-bye.
[CUSTOMER][NEUTRAL] You too, bye.