AccountId: 011433970860
ContactId: b2bb9654-47af-4b58-bd27-7d08b654df43
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1108439 ms
Total Talk Time (AGENT): 330806 ms
Total Talk Time (CUSTOMER): 405459 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/b2bb9654-47af-4b58-bd27-7d08b654df43_20250402T15:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello [PII]. This is [PII] calling from provider's office to check up on a claim status. Also, this call has been recorded for quality and training purposes. Are you OK with that?
[AGENT][NEUTRAL] Sure, yeah, I can check on a claim for you. I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] It's [PII] spelled as [PII] to my last name would be [PII]. Also, can you spell out your name for me?
[AGENT][NEUTRAL] Sure, it's [PII] last initial is [PII]
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Of course. Alrighty, and then, uh, [PII], can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] Uh yeah, it would be [PII].
[AGENT][NEUTRAL] OK, thank you. And then did you have that policy number?
[CUSTOMER][NEUTRAL] Yeah, it's 022 05790. M as in Mike, L as in Lima number 8.
[AGENT][NEUTRAL] OK, and what was the name and date of birth for the member, please?
[CUSTOMER][NEUTRAL] Yeah, it's called.
[CUSTOMER][NEUTRAL] [PII], date of birth is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that. What was the date of service for this claim?
[CUSTOMER][NEUTRAL] D of service is [PII].
[CUSTOMER][NEUTRAL] Total charge $4,054 even.
[AGENT][NEUTRAL] OK, thank you. One moment please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so we did receive this claim, uh, looks like we're missing a copy of the primary EOB.
[CUSTOMER][NEUTRAL] Actually, we did received payment.
[CUSTOMER][NEUTRAL] For 3 and $350. Yeah, I do have it's 350.
[AGENT][NEUTRAL] Do you have that claim number?
[AGENT][NEUTRAL] Oh, is that the amount after? OK, yes, go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] Yeah it's 350-6593.
[AGENT][NEUTRAL] 593. OK.
[AGENT][NEUTRAL] OK, yes, I see that we, uh, made a payment of $350.
[CUSTOMER][NEUTRAL] Actually, I just need to know why you have paid only $350 because uh the primary insurance has processed patients responsibility for $1,472.83.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Sure, so that amount, that $350 met their maximum amount payable for this policy for this date of service.
[CUSTOMER][NEUTRAL] And how much is that?
[AGENT][NEUTRAL] See, one moment, let me get that so their outpatient benefit was $350 max per calendar day.
[CUSTOMER][NEUTRAL] For calendar day.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, sure. Uh, no problem. Thank you.
[AGENT][NEUTRAL] Yeah, was there anything else I can help you with?
[CUSTOMER][NEUTRAL] I do have some more claims with me. Can you help me with those claims as well?
[AGENT][NEUTRAL] Is this going to be for the same member or for a different member?
[CUSTOMER][NEUTRAL] It's for the different member.
[AGENT][NEUTRAL] OK, one moment, I'll let you know when I'm ready to proceed to those next ones.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. I am ready for that next policy number.
[CUSTOMER][NEUTRAL] Yeah, it would be 02415265 M as in Mike L as in Lima number 8.
[AGENT][NEUTRAL] OK and then uh the name and date of birth for this member please?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth is [PII].
[CUSTOMER][NEUTRAL] Oh sorry, uh, it's [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. And then uh what was the date of service? That's OK. What was the date of service for this claim?
[CUSTOMER][POSITIVE] I'm sorry for that.
[CUSTOMER][NEUTRAL] It's [PII]. Total charge $5000 even.
[AGENT][POSITIVE] 500 even. OK, thank you one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Do you have that amount after major medical paid?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's $569.38 and you have paid only $400 yeah.
[AGENT][POSITIVE] OK, perfect, thank you.
[AGENT][NEUTRAL] Yes, OK, give me just a moment, let me see that.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so this one also met their maximum for the date of service. This policy is similar to the other except this one pays $400 max per calendar day.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] And the claim number is
[CUSTOMER][NEUTRAL] Can you help me with the claim number?
[AGENT][NEUTRAL] Yes, um, that is 346-69887.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Just a moment. Yeah. Can we move to the next number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, go ahead.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It would be 600974347.
[AGENT][NEUTRAL] OK. Uh, that's a bit long to be one of our policy numbers. Um, is that their member ID?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Just a moment
[AGENT][NEGATIVE] Yeah, I didn't get a result with that.
[CUSTOMER][NEUTRAL] Yeah, the member ID.
[CUSTOMER][NEUTRAL] Yeah, I do have a member ID.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's 00974347.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And what was the name and date of birth for the member?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. What was the date of service for this claim?
[CUSTOMER][NEUTRAL] It's [PII] and the total charge is $1,872.47. Here is also the same scenario like previous one.
[AGENT][NEUTRAL] OK, OK, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What was the remaining balance after major medical paid?
[CUSTOMER][NEUTRAL] It's for procedure code 76831 procedure code 76831, it's $340.89 and for another procedure code 558,340, it's $305.46.
[AGENT][NEUTRAL] Got it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Got it, yes, OK, so this one is, uh, this one met their maximum as well, um, give me just a moment.
[AGENT][NEUTRAL] So this policy was on a calendar year basis, um, so it's $750 max per calendar year and that had been met with this payment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, you mean to say only $240 are left?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And you have paid that for this one, this data service.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and the claim number is 3561283.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, thank you. Can we move to the next number?
[AGENT][NEUTRAL] Uh, one moment, please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] OK, I appreciate your patience. You can go ahead with that next policy number.
[CUSTOMER][NEUTRAL] Yes, sure. It would be 018.
[CUSTOMER][NEUTRAL] 458 48 M as in Mike L as in Lima number 8.
[AGENT][NEUTRAL] OK and then uh the name and date of birth for this number please?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for that and then what was the date of service for this one?
[CUSTOMER][NEGATIVE] Yeah, I do have two claims for the same date of service. Uh, the, yeah, the date of service is [PII], and the total charge is $500 even.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The second one is for the same date of service, the charge amount is $620 even $600.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, is that the amount before or after major medical paid?
[CUSTOMER][NEUTRAL] Uh, it's before, after Medicare paid, uh, the amount for $500 it's actually $460 with 1 cent, and for another claim.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, and for another claim, uh, procedure for procedure code G0279, it is $148.55.
[AGENT][POSITIVE] OK, got it. Thank you. One moment.
[CUSTOMER][POSITIVE] Yeah thank you.
[AGENT][NEUTRAL] OK, so I did find the claim uh for the $460.01 that was procedure code 76641 uh for this one we did pay a benefit of $401.45. Give me just a moment, and that met their maximum, let me see what that was.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] OK, so this, um, their maximum was $1000 per calendar year and so this one met their maximum.
[CUSTOMER][NEUTRAL] $1000.
[AGENT][NEUTRAL] Per calendar year, yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you're going to say there there is left only.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] There's only $851 left.
[AGENT][NEUTRAL] That payment that we made, uh, met their maximum, so that was the remaining balance for the calendar year. I'm sorry, what was the other um amount after major medical paid? I'm so sorry.
[AGENT][NEUTRAL] So that was $148. Uh-huh.
[CUSTOMER][NEUTRAL] It was 148.
[CUSTOMER][NEUTRAL] Yeah, and 55 cents.
[AGENT][NEUTRAL] And 55 cents, OK.
[AGENT][NEUTRAL] OK, I'm not showing that we've received a claim for that amount from a provider.
[CUSTOMER][NEUTRAL] Actually we did receive payment for $450. Just give me a moment.
[CUSTOMER][NEUTRAL] Actually, the claim, uh, for $620 after the Medicare paid, uh, the amount was left.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is $450 for procedure code 77066 yeah and for another code it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yeah, I do see that one.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, I don't see another one for that amount though, but yes, OK, so this one was paid um before that other one, so we did pay that full amount.
[AGENT][NEUTRAL] The 450.
[CUSTOMER][NEUTRAL] And for another code $148.55.
[AGENT][NEUTRAL] Again, I'm not showing that we've received um a claim from a provider for that amount for this state of service.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Can you help me with the claim number for that one?
[AGENT][NEUTRAL] Uh, for the one that was $450.
[CUSTOMER][NEUTRAL] Uh, 450.
[AGENT][NEUTRAL] Yeah, the one that
[CUSTOMER][NEUTRAL] Uh, for both of.
[AGENT][NEUTRAL] Oh, yeah, so the one for $450 that was 356-4172.
[AGENT][NEUTRAL] And then the other one that was 356-560-0.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] OK, thank you so much for your help. Uh, can we move to the next number?
[AGENT][NEUTRAL] Yeah, was there anything else I could help you with?
[AGENT][NEUTRAL] 01 moment. OK, yes, one moment please. I'll let you know when I'm ready.
[CUSTOMER][POSITIVE] Yeah, I do have one more.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK. Uh, you can go ahead with that next policy number.
[CUSTOMER][NEUTRAL] It would be 025.
[CUSTOMER][NEUTRAL] 43839.
[AGENT][NEUTRAL] OK, and then the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] OK, uh, what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Date of service is [PII]. Total charge $500 even.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEGATIVE] OK, this one is also missing a copy of the primary EOB.
[CUSTOMER][NEUTRAL] Actually we have already submitted that on [PII].
[AGENT][NEGATIVE] I'm not showing that we have received that. That might need to be resent to us.
[CUSTOMER][POSITIVE] OK, sure, no problem. I can resubmit that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I just need to uh uh confirm the claim number is it 3551397?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] OK, thank you so much. And what would be the call reference number for the entire call?
[AGENT][NEUTRAL] Uh, reference number would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII] Last initial is [PII] Was there anything else I could help you with?
[CUSTOMER][POSITIVE] Uh no, thank you so much. That's it for the day. Hope you have a wonderful day.
[AGENT][POSITIVE] Of course, thanks for calling APL you too bye bye.
[CUSTOMER][POSITIVE] Bye-bye. Take care.
[AGENT][NEUTRAL] You too.