AccountId: 011433970860
ContactId: 937a6433-1efa-42fa-a6b9-f26af12c9b67
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 934739 ms
Total Talk Time (AGENT): 304137 ms
Total Talk Time (CUSTOMER): 293755 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/2025/02/26/937a6433-1efa-42fa-a6b9-f26af12c9b67_20250226T14:32_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office, checking on a claim status.
[AGENT][NEUTRAL] OK, you, I can verify claim status for you and [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] Uh, it's 02462-264 ML 8.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh it's [PII].
[CUSTOMER][NEUTRAL] [PII] and the extension will be [PII].
[AGENT][NEUTRAL] OK, thank you. And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Yeah, the patient name is [PII]. And the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And [PII], you say you're calling for claim status, correct?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, actually, what is, uh, I received a payment here. I do have, I see a payment of $400.
[CUSTOMER][NEUTRAL] And the remaining balance is uh
[CUSTOMER][NEUTRAL] Uh, just a moment.
[CUSTOMER][NEUTRAL] Yeah, and also have a, a remit code with uh stating uh benefits maximum has been reached.
[AGENT][NEUTRAL] OK, uh, what is that claim number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, it's 3551376.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, sorry, I missed your name. Uh, what's the name you told?
[AGENT][NEUTRAL] Sure, it's [PII] last initial [PII], and yes, it looks like the claim paid 400 and it looks like with that payment it matched the patient benefit for the data service.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And uh whether it's a dollar value or the number of visits.
[AGENT][NEUTRAL] It's a dollar value.
[CUSTOMER][NEUTRAL] OK. Uh, could you
[CUSTOMER][NEUTRAL] Uh, what's the maximum dollar value?
[AGENT][NEUTRAL] Uh, per the patient's policy, they have an outpatient benefit that pays up to $400 per calendar day. And with the payment of this claim, it match the benefit for that date.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] And can I build the patient?
[AGENT][NEUTRAL] Well, we can't give patient responsibility. We can't give patient responsibility. We can only verify how the claim was processed.
[CUSTOMER][NEUTRAL] For the remaining balance.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] OK. And [PII], is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah. Actually, I have, uh, how many claim you can assist me with?
[AGENT][NEUTRAL] What's the next claim? Is it for the same patient or different patient?
[CUSTOMER][NEUTRAL] It's for a different patient.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. And what is the next policy number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And it is
[CUSTOMER][NEUTRAL] 01816168.
[AGENT][NEUTRAL] OK. And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII].
[CUSTOMER][NEUTRAL] And then date of birth is [PII].
[AGENT][NEUTRAL] OK. And what was the date of service and amount of the charge, or do you have this claim number as well?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, I do have a claim number. And uh
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's 356-052-6.
[AGENT][NEUTRAL] OK, and on this claim, it looks like we paid $1500 and with that payment, it matched their benefit for the data service.
[CUSTOMER][NEUTRAL] Uh, this is also for the, uh, dollar value, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Can I go with the next one?
[AGENT][NEUTRAL] Uh, give me one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and what's the next policy number?
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] 02413470 ML 8.
[AGENT][NEUTRAL] OK. And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] OK, and the claim number if you have it?
[AGENT][NEUTRAL] Or the data service and the amount of the charge.
[CUSTOMER][NEUTRAL] No, I don't have it.
[AGENT][NEUTRAL] OK, and what's the date of service and amount of the charge?
[CUSTOMER][NEGATIVE] Uh, no.
[CUSTOMER][NEUTRAL] The date of service is [PII].
[CUSTOMER][NEUTRAL] And the total charge amount here is $2180.
[AGENT][NEUTRAL] OK, and do you have the balance after primary insurance has processed the claim?
[CUSTOMER][NEUTRAL] Yeah, I do have a balance with $50.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And just to let you know, we do have an online service center where providers can check claim status as well as print out the EOB. That site is at [PII]. And [PII], what was the name of the provider's office you're calling about on this claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's Holy Cross Hospital.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, I'm showing this claim process as the outpatient benefit has maxed for the calendar year.
[CUSTOMER][NEUTRAL] Uh, there's no amount payable?
[AGENT][NEUTRAL] The claim process as the benefit max for the calendar year, so there is no payable benefit.
[CUSTOMER][NEUTRAL] Got it. Uh, can I get, uh, could you provide me the maximum?
[CUSTOMER][POSITIVE] Uh, benefits of this.
[AGENT][NEUTRAL] Uh, the insured, the insured has a benefit max for outpatient of $1250 and they've already met that max for that year.
[CUSTOMER][NEUTRAL] The $8 a month.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] And could you provide me the call reference, sorry, uh, the claim number?
[AGENT][NEUTRAL] Uh, the claim number is 354-835-8.
[CUSTOMER][NEUTRAL] And could you fax me the uh EOP for this?
[AGENT][NEUTRAL] As I stated, we do have an online service center where providers can check claim status as well as pronounce the EOB. That site is at secured. [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Great.
[AGENT][NEUTRAL] OK, and is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Uh, actually, I have another 2 claims to go with.
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and what is the next policy number?
[CUSTOMER][NEUTRAL] It's 02478718.
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] OK. And patient's name, date of birth?
[CUSTOMER][NEUTRAL] Patient name is
[CUSTOMER][NEUTRAL] [PII]. And the date of birth is [PII]. And I have a claim number here.
[AGENT][NEUTRAL] OK, what's that claim number?
[CUSTOMER][NEUTRAL] It's 352-924-0.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] This was for data service [PII].
[CUSTOMER][POSITIVE] Yeah, that's right.
[AGENT][NEUTRAL] OK, I'm showing a claim process and pay 200 $200 well, $200 211 1 cents, and with that payment, it matched their benefits for the data service.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK give me one moment.
[CUSTOMER][NEUTRAL] Uh, can I go with the next one?
[AGENT][NEUTRAL] Uh, give me one moment.
[CUSTOMER][NEUTRAL] Yeah, so
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and what's that last policy number, please?
[CUSTOMER][NEUTRAL] It's 02161356 ML 8.
[AGENT][NEUTRAL] OK. And uh
[CUSTOMER][NEUTRAL] I don't have a claim number for this.
[AGENT][NEUTRAL] OK, verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Patient name is
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] OK, and what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And the total charges is $1,149 even.
[AGENT][NEUTRAL] OK, and the balance after primary?
[CUSTOMER][NEUTRAL] It's $275 even.
[AGENT][NEUTRAL] OK, thank you. And you said uh the date of service was [PII], is that correct?
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, I'm showing in this claim, it looks like we paid 275.
[AGENT][NEUTRAL] And a check was mailed.
[AGENT][NEUTRAL] Excuse me, on [PII] of this year.
[CUSTOMER][NEUTRAL] A me.
[CUSTOMER][NEUTRAL] Yeah, when the claim was received?
[AGENT][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] It was received on [PII].
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Well, it looks like we received the claim previously, initially processes needing primary EOB that was received and the claim was paid, but it appeared the check came back and so it was reissued on [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] Can I have the check number?
[AGENT][NEUTRAL] 202-827-6.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And the check date and the issue date are the same. It's Feb [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] What's the check amount?
[AGENT][NEUTRAL] It's for $275.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] And also, could you verify the uh pay to address?
[AGENT][NEUTRAL] Sure. Give me one moment, please.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] Uh, it was mailed to [PII]. Is that correct?
[CUSTOMER][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] And is it cash or still outstanding?
[AGENT][POSITIVE] I'm showing it's still outstanding.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] And also could you provide me the call uh sorry claim number?
[AGENT][NEUTRAL] Uh, the claim number is 356-494-6.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] OK. And [PII], is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] No, uh, I got all the information I needed and thanks for that, [PII].
[AGENT][POSITIVE] Alright, you're welcome. Thank you for calling APL and you have a great day.
[CUSTOMER][NEUTRAL] And uh the call reference.
[AGENT][NEUTRAL] Uh, we don't give reference numbers, but you may use my name in today's date.
[CUSTOMER][NEUTRAL] Before finding up the call.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] And once again, thanks for the information provided and have a great day. Bye-bye.
[AGENT][POSITIVE] Alright, you too. Thank you for calling APL. Bye.