AccountId: 011433970860
ContactId: 952c94f9-9d3e-407e-845a-a58796a49e8c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 445720 ms
Total Talk Time (AGENT): 146177 ms
Total Talk Time (CUSTOMER): 184553 ms
Interruptions: 0
Overall Sentiment: AGENT=2.2, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/952c94f9-9d3e-407e-845a-a58796a49e8c_20250217T22:19_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] Hey, [PII]. This is [PII] calling from Washington University. I need your help to check the patient claim.
[AGENT][POSITIVE] Well, it would be my pleasure to assist you. Do you mind spelling your name?
[CUSTOMER][NEUTRAL] Uh, [PII] I pronounced [PII].
[AGENT][POSITIVE] Thank you, [PII] and what is a good call back number?
[CUSTOMER][NEUTRAL] [PII] that's direct direct line?
[AGENT][NEUTRAL] Thank you. And what is a good, uh, what is the policy number for the patient? I'm sorry.
[CUSTOMER][NEUTRAL] 01897871
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth please, ma'am?
[CUSTOMER][NEUTRAL] Um, [PII], [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][POSITIVE] And it would be my pleasure to assist you with claim information. Do you have a claim number or date of service?
[CUSTOMER][NEUTRAL] Claim number is
[CUSTOMER][NEUTRAL] Um, 353-7892.
[AGENT][NEUTRAL] Thank you and for what data service and build amount is that?
[CUSTOMER][NEUTRAL] Um, the service is [PII], total is 395.
[AGENT][POSITIVE] Thank you for the department of pathology.
[CUSTOMER][NEUTRAL] Oh yes.
[AGENT][NEUTRAL] Alright, thank you. Yeah, I can help you with that claim information. Uh, it was denied because the outpatient benefit for the calendar year has been met.
[AGENT][NEUTRAL] [PII] has an outpatient benefit of $3500 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That we can pay toward her deductible co-pay or co-insurance.
[CUSTOMER][NEUTRAL] Yeah, um, I just need the EOB, uh, last time when I called and I was told this information, but I cannot, cannot get the EOB yet.
[AGENT][NEUTRAL] OK, I'll be happy to fax that to you now also we have a provider portal where you have 24/7 access to EOB's claim status as well as claim submission.
[AGENT][NEUTRAL] And that is at [PII]
[AGENT][NEUTRAL] [PII] and if you would like I can help you create a login and password real quick and get that EOB.
[CUSTOMER][NEUTRAL] OK, yeah, good, uh, I try to create my account, so let me set up a username first. OK, bear with me. I'm, I'm in the middle, um.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Take your time.
[AGENT][NEUTRAL] And you use that patient account number EWU 517509.
[AGENT][NEUTRAL] 031
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] OK, good.
[CUSTOMER][NEUTRAL] I do, uh, let me set it up for you the date, um.
[CUSTOMER][NEUTRAL] Password.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And that way you'll have it in hand.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Uh, what's that one symbol.
[CUSTOMER][NEUTRAL] It's to show the uh one number, one symbol. oh, password would need symbol. OK, I need to change that.
[CUSTOMER][NEUTRAL] OK, next.
[CUSTOMER][NEUTRAL] I'm submitting the.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Aunt, OK, it's working right now. Oh, right.
[AGENT][POSITIVE] That's fine. Take your time.
[CUSTOMER][NEUTRAL] Why so slow?
[AGENT][NEUTRAL] Sometimes computers are that way, aren't they?
[CUSTOMER][NEUTRAL] Uh, I'm not sure. It's look, looks like, oh, your account has been successfully created. Let me log in. OK, um.
[CUSTOMER][NEUTRAL] Bye
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, I log in. So now I can pull this maybe EOB. Let me take a look what they need. They need the claim number, right? So, oh, that's and I still need the call you get the claim number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, and you've got the claim number.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Patient date of birth?
[CUSTOMER][NEUTRAL] I search.
[CUSTOMER][POSITIVE] Yeah, I got it um.
[CUSTOMER][NEUTRAL] I got the claim and I clicked the EOB.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It should just getting downloaded and that probably need the time.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Uh.
[AGENT][POSITIVE] Now let's make sure you get it because I wanna make sure you have it.
[CUSTOMER][POSITIVE] Oh yeah, I got it. You'll be great. That's so good. OK, thank you so much for your, for your help. Appreciate it.
[AGENT][POSITIVE] It's been my pleasure. Is there anything else I can help you with?
[CUSTOMER][NEGATIVE] But you didn't see anything. It shows uh
[CUSTOMER][NEGATIVE] Remark code is 1 and DED is 0, DED 00. What's that mean? The product does not have a provider network. Benefits have not been reduced and what they didn't tell me, oh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The next page, yeah, the next page.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, next page they said outpatient benefits for calendar year has been met, but they didn't tell me how much patient response, right? They just this.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, so we're, that's right, we are secondary to their major medical. There's no contractual involvement in the processing of the claim and we don't determine patient responsibility.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It, it's like a supplemental policy.
[CUSTOMER][NEUTRAL] Yeah, that's a policy, right?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] OK, great. Thank you so much.
[AGENT][POSITIVE] My pleasure. Anything else I can help you with?
[CUSTOMER][NEUTRAL] That's it.
[AGENT][POSITIVE] Well thank you for calling APL. I hope you have a good evening.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye bye