AccountId: 011433970860
ContactId: abf7c5dd-cd6e-4fcb-a06c-d2007a2edb56
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 282260 ms
Total Talk Time (AGENT): 138128 ms
Total Talk Time (CUSTOMER): 104657 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/31/abf7c5dd-cd6e-4fcb-a06c-d2007a2edb56_20241231T18:43_UTC.wav
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[AGENT][NEUTRAL] Good afternoon, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from a provider's office and I just wanna check and see um if there's a patient balance on one of our claims.
[AGENT][NEUTRAL] OK, you're wanting to check claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, I can help you with that, [PII]. What is your callback number?
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] [PII] it's [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] We have.
[CUSTOMER][NEUTRAL] D as in dog 404-07416
[AGENT][NEUTRAL] OK, now that is not an APO policy number, that is a 90 degree benefit number. Were you trying to reach APL or 90 degree benefits?
[CUSTOMER][NEUTRAL] No, the, the remit or the EOB we got was from you guys, so let me just check and see.
[AGENT][NEUTRAL] OK, so there is a policy number on the EOB.
[CUSTOMER][NEUTRAL] So it's uh 02334600.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] And any information that I do provide for you today, will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And the date of service and total bill amount?
[CUSTOMER][NEUTRAL] [PII] and the billed amount is $11,262 even.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] And the claim number?
[CUSTOMER][NEUTRAL] 3343639
[AGENT][NEUTRAL] OK. So on here, I see that there was a $50 benefit paid on this claim.
[AGENT][NEUTRAL] Uh, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Looks like 150.
[AGENT][NEUTRAL] I'm sorry, yes, 150.
[AGENT][NEUTRAL] And on this.
[AGENT][NEUTRAL] Because this is a limited benefit plan, [PII], with this check, the maximum benefit payable for this state of service has been met.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on the other code, it was the calendar year max for the benefit has been exhausted with the payment of this claim.
[AGENT][NEUTRAL] And we do not determine patient responsibility, that would be up to the provider.
[CUSTOMER][POSITIVE] OK, um, the limited benefit plan is, is very helpful because that's not on the card, on the insurance card, so I appreciate the information. Do you have a.
[AGENT][POSITIVE] Absolutely. Yes, ma'am. You're very welcome.
[CUSTOMER][NEUTRAL] Do you have a call reference number?
[AGENT][NEUTRAL] Sure, you would use my name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And future if you need copies of any of the explanation of benefits on our members, you can, that we have processed claims for Chevon, you can go to our portal, it's secured.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And create a profile where you can print from there as well in case you didn't know that.
[CUSTOMER][NEUTRAL] Yeah, I'm
[CUSTOMER][NEUTRAL] Yeah, so I'm actually looking at the EOB from your portal. I just, I just couldn't see that it was a limited benefit plan.
[AGENT][NEUTRAL] Oh, OK. OK.
[AGENT][NEUTRAL] There's
[CUSTOMER][NEGATIVE] I don't wanna, you know, I don't wanna send a big old balance to the patient if.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] You know, there's something else going on, you know.
[AGENT][NEUTRAL] Yeah, on her ID card that she should have for APL though that would have that policy number on it, it should say um.
[AGENT][NEUTRAL] Hospital indemnity, it should have that information on that.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Mhm. Yes.
[CUSTOMER][NEUTRAL] I mean she gave us the 90 degrees insurance card.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] Yeah. So that's why, you know, but yes, this is a limited, sure. Yes, you didn't have all the information. I know that it was, but yeah, it's a limited benefit plan, not a major medical.
[CUSTOMER][NEUTRAL] Yeah, it was just a little confusing, yeah.
[CUSTOMER][POSITIVE] Wonderful, thank you for your time, [PII]. I hope you have a good new year.
[AGENT][POSITIVE] OK. Well, I hope you have a happy New Year to you, [PII], and if that's all I can help you with, and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] Bye-bye.