AccountId: 011433970860
ContactId: 97465e71-8771-4dd0-a00e-0889220487c2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 337899 ms
Total Talk Time (AGENT): 104891 ms
Total Talk Time (CUSTOMER): 89529 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/97465e71-8771-4dd0-a00e-0889220487c2_20250304T18:27_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling ATO. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, so, uh, this is [PII] with Community Hospital. I need to make sure you have a claim on file for one of your members, please.
[AGENT][NEUTRAL] OK, sure. I can assist you with claims and you said you're calling from Memorial Hospital?
[CUSTOMER][NEUTRAL] No community hospital.
[AGENT][NEUTRAL] Community, OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, thank you. And may I have a callback number just in case we get disconnected, Ms. [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 01871927.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] What's the name of the patient?
[CUSTOMER][NEUTRAL] Uh, [PII], uh, [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Oh my [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] That's not. Let me have that policy number one more time.
[CUSTOMER][NEUTRAL] 01871927.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] OK. OK. All right. And what is the date of service for the claim?
[CUSTOMER][NEUTRAL] Uh, [PII] original build amount was.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 36 $46.10.
[CUSTOMER][NEUTRAL] And let's see, this claim was mailed out to you guys on [PII] with the primary you'll be attached.
[AGENT][NEUTRAL] OK, let me see I have.
[AGENT][NEUTRAL] OK, let me pull this up here one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Still waiting on the system.
[CUSTOMER][NEUTRAL] It's OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Oh, let me look at the claim. The amount is a little bit different. Let me check.
[CUSTOMER][NEUTRAL] Uh well it might be 10.
[CUSTOMER][NEUTRAL] I don't know what the let's see.
[CUSTOMER][NEUTRAL] Looks like they took
[CUSTOMER][NEUTRAL] Uh, let me go back in here.
[CUSTOMER][NEUTRAL] Let's see exactly what the claim.
[CUSTOMER][NEUTRAL] 35,505 $35,500.54 so I told you.
[AGENT][NEUTRAL] Yes, OK, yeah, mhm, that's the one we have, uh.
[CUSTOMER][POSITIVE] OK, so it sounds like you got it right.
[AGENT][NEUTRAL] All right. So it looks like we processed the claim on [PII] and we send a benefit amount of $4,582.28.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 4000 what was that? 4000.
[AGENT][NEUTRAL] $4,582.28. And it looks like with the payment of the check, the maximum has been exhausted.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, and is it because the balance at the Blue Cross Shield paid on it was 6,39662. So is the patient responsible for the difference between your payment and that?
[AGENT][NEUTRAL] Um, we don't have any contractual involvement in the remaining, but, um, it's up to the provider's discretion, but she used all her benefits with that payment. She has asked her benefit.
[CUSTOMER][NEUTRAL] OK, so 4000 plus, alright, alright, um, do you have a check number on that one, please?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, I do. Um, the check number is 2029792.
[CUSTOMER][NEUTRAL] And you it was issued on 226?
[AGENT][NEUTRAL] 226 of 25. Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and you guys do reference numbers?
[AGENT][NEUTRAL] No, we don't. You can use my name in today's name.
[CUSTOMER][POSITIVE] Sounds great thank you have a great night.
[AGENT][POSITIVE] You're welcome. You as well. And thank you for calling APO. Have a good day, Mr. [PII]. Bye-bye.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Bye.