AccountId: 011433970860
ContactId: ac761fbd-20a2-4d37-b675-80ccae8bc05d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 452980 ms
Total Talk Time (AGENT): 182559 ms
Total Talk Time (CUSTOMER): 145749 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/ac761fbd-20a2-4d37-b675-80ccae8bc05d_20250206T14:54_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh hello, [PII]. This is [PII]. I'm calling from provider's office checking for claim status.
[AGENT][POSITIVE] Thank you. It would be my pleasure to assist you. Did you say your name is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] All right, thank you [PII]. What is a good callback number please?
[CUSTOMER][NEUTRAL] Yeah. Uh, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And [PII], what is the policy number for the patient, please?
[CUSTOMER][NEUTRAL] Yeah, one moment.
[CUSTOMER][NEUTRAL] Yeah. It's 01894924 M as in Mary, L as in Lima, 8.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the patient's name and date of birth, please?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. It's [PII].
[CUSTOMER][NEUTRAL] And [PII], his date of birth.
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] All right, thank you, [PII], and it would be my pleasure to help you with that claim status. Do you have a claim number or data service?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] I have a date of service.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is that date? OK, thank you.
[CUSTOMER][NEUTRAL] One moment, please.
[CUSTOMER][NEUTRAL] Yeah, yeah, it's [PII].
[AGENT][NEUTRAL] And what is the bill amount, please, sir?
[CUSTOMER][NEUTRAL] It's $29,051.75.
[AGENT][NEUTRAL] And what is the facility name?
[CUSTOMER][NEUTRAL] Holy Cross Hospital?
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm checking, bear with me just one second.
[CUSTOMER][POSITIVE] OK, take your time, no problem.
[AGENT][POSITIVE] Thank you, [PII].
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Let's see, we did receive that claim.
[AGENT][NEUTRAL] The claim was received on [PII].
[AGENT][NEUTRAL] It was processed and paid on [PII].
[AGENT][NEUTRAL] And a benefit amount of $2690.44 was sent to Holy Cross Hospital.
[CUSTOMER][NEUTRAL] OK. Uh, actually, we have, uh, in, in this information in our system.
[CUSTOMER][NEUTRAL] And uh it is actually Medicare uh processed and paid and applied to the, to deductibles as uh $2690.44. And after remaining that 2,689.53 cents is co-insurance.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I need you have any information about this this amount in your system?
[AGENT][NEUTRAL] So we were not able to pay that complete amount because when we received this claim, the remaining benefits.
[AGENT][NEUTRAL] For that calendar year was $2690.44 and that maxed out the inpatient hospital benefit for the year.
[CUSTOMER][NEUTRAL] OK and uh.
[AGENT][NEUTRAL] They have a calendar year amount benefit or had $3500 per calendar year.
[CUSTOMER][NEUTRAL] OK, it is uh include uh it is all met on including this claim.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 3500.
[AGENT][NEUTRAL] Yes sir, when we paid when we received your claim, the the remaining benefit amount was $2690.44 and we did pay that benefit and that maxed out that benefit for 2024.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Is there any remaining amount for the calendar year for [PII] in the 33,500?
[AGENT][NEUTRAL] No, sir.
[AGENT][NEUTRAL] No, sir. With the payment of the, the benefit payment for Holy Cross Hospital that maxed it out.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, [PII], can I get claim number for this claim?
[AGENT][NEUTRAL] Sure, the claim number is 352.
[AGENT][NEUTRAL] 493 8
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK. [PII], can I get call reference number?
[AGENT][NEUTRAL] Call reference number is my name and today's date, and I spell my name [PII].
[CUSTOMER][POSITIVE] Thank you [PII] yeah. I have a one more client for you provide the information.
[AGENT][NEUTRAL] Is it for the same patient or different patient?
[CUSTOMER][NEUTRAL] Different patients.
[AGENT][NEUTRAL] All right, I can help you with that, [PII]. One moment.
[AGENT][NEUTRAL] And what is that next policy number?
[CUSTOMER][NEUTRAL] Yeah, uh 02184704 M as in Mary, L as in Lima, number 8.
[AGENT][NEUTRAL] And what is that patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII] is date of birth.
[AGENT][NEUTRAL] All right, thank you. And what is that data service?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And that bill them out, please, sir.
[CUSTOMER][NEUTRAL] It's 4,0006.
[CUSTOMER][NEUTRAL] Uh, $4,065 even.
[AGENT][NEUTRAL] Same facility, [PII]?
[CUSTOMER][NEUTRAL] Yes, it's Holy Cross Hospital.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And that claim we received on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] Now this claim was denied as services were rendered after the policy termed.
[CUSTOMER][NEUTRAL] May I know the policy effective on term day?
[AGENT][NEUTRAL] Mhm. The effective date is [PII] and the policy termed on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] At least, uh, patient have any other active interest on data service?
[AGENT][NEUTRAL] And not with APL.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is a call reference number, same, right? Your name and date, today's date, right?
[AGENT][NEUTRAL] It is.
[CUSTOMER][POSITIVE] OK. Thank you. Thank you so much for providing this information is there.
[AGENT][POSITIVE] It's been my pleasure to assist you with that claim status, [PII]. Anything else I can help you with today?
[CUSTOMER][POSITIVE] I think that's it for today. Thank you.
[AGENT][POSITIVE] And thank you for calling APLJ. I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][POSITIVE] Thank you. Bye bye.