AccountId: 011433970860
ContactId: b3686232-d420-4e35-8f01-29401b4f51e2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 466790 ms
Total Talk Time (AGENT): 157879 ms
Total Talk Time (CUSTOMER): 140561 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/b3686232-d420-4e35-8f01-29401b4f51e2_20250520T22:03_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm a provider calling on a claim please.
[AGENT][NEUTRAL] Yeah, I could check on a claim for you. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure it's a direct line [PII].
[AGENT][NEUTRAL] Thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] 01897871 for [PII].
[AGENT][NEUTRAL] OK, and do you have uh her date of birth?
[CUSTOMER][NEUTRAL] [PII] and I know you told me your name, I already forgot it.
[AGENT][NEUTRAL] That's OK. It's uh [PII]
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And I appreciate you verifying that information, uh huh and what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK and then do you have that bill amount?
[CUSTOMER][NEUTRAL] $24,413.45.
[AGENT][NEUTRAL] OK, one moment please.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] OK, um, that amount was that uh before or after major medical paid [PII]?
[CUSTOMER][NEUTRAL] Uh, before the total bill charge.
[AGENT][NEUTRAL] OK, do you have that remaining balance by chance?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] So the full remaining balance is 4,30922.
[AGENT][POSITIVE] Perfect. OK, I do believe I found it. Give me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Was this with uh Progress West Healthcare Center?
[CUSTOMER][NEUTRAL] Um, yes, ma'am.
[AGENT][NEUTRAL] Awesome, OK, so for this claim, uh, we did, we paid a benefit of uh $3,027.54.
[AGENT][NEUTRAL] See, and that did meet their calendar year maximum.
[AGENT][NEUTRAL] I've got that claim number whenever you're ready.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, I actually do have that payment of $3,027.54. It looks like I'm showing a remaining balance of 1,28168.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] You guys only pay a certain percent?
[AGENT][NEUTRAL] No, so the amount that.
[CUSTOMER][NEUTRAL] Of the coinsurance and deductible.
[AGENT][NEUTRAL] No, so the amount that we paid met their calendar year maximum uh for their inpatient benefit. You give me one moment, I can let you know exactly what that is.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] So per calendar year, uh, this policy pays $3500 max per calendar year and so with this payment it met that maximum.
[CUSTOMER][NEUTRAL] So with the remaining balance then be patient responsibility since it's since it's paid the max?
[AGENT][NEUTRAL] Mm, so we don't say what is patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] So they already met their max in this year for [PII].
[AGENT][POSITIVE] Correct for their inpatient benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so let me see here, inpatient.
[CUSTOMER][NEUTRAL] OK, and I need help with one more claim when you when I'm done with this one.
[AGENT][NEUTRAL] Sure, is this for the uh the same member?
[CUSTOMER][NEUTRAL] Uh, let me check one second.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Um, it's a different number.
[AGENT][NEUTRAL] OK, um, so if you'll give me one moment I'll finish these notes and then I'll let you know when I'm ready for that next policy number.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] OK, I appreciate your patience. Uh, whenever you're ready you can go ahead and give me the policy number.
[CUSTOMER][NEUTRAL] All right, it is 02263101 for [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and uh his date of birth please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK thank you and then what was the date of service for this one?
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] Oh sorry, [PII].
[AGENT][NEUTRAL] Oh no, you're fine.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, and then uh that bill out please.
[CUSTOMER][NEUTRAL] It is $37,290.78.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK and then did you have that remaining balance after major medical paid?
[CUSTOMER][NEUTRAL] 6,18614.
[AGENT][POSITIVE] OK awesome one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Was this through a different provider?
[CUSTOMER][NEUTRAL] Uh, you know what, yes, it is.
[AGENT][NEUTRAL] OK, I got a little tripped up there. I wanted to make sure this one is this Barnes Jewish Hospital?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, OK, wanted to make sure, alrighty, so for this one, we paid a benefit of $1,918.72. Let's see.
[AGENT][NEUTRAL] And with this payment, the check, uh, the policy maximum for this benefit has been met.
[CUSTOMER][NEUTRAL] OK, so that is all I need.
[AGENT][NEUTRAL] Oh this is their
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Max and what is their max benefit? Is it the same?
[AGENT][NEUTRAL] Give me just a moment and I doubt it um well this one was for outpatient as well so let me see they're all a bit different.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Oh well you know what this one is the same actually um outpatient calendar year is $3500.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][POSITIVE] OK, all right, that is all I need thank you so much for your time.
[AGENT][POSITIVE] Alright absolutely thanks for giving us a call up you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you. Bye-bye.