AccountId: 011433970860
ContactId: b533ae3f-cac2-43e0-a693-3f14267f9a75
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 446339 ms
Total Talk Time (AGENT): 131006 ms
Total Talk Time (CUSTOMER): 165935 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/b533ae3f-cac2-43e0-a693-3f14267f9a75_20250520T16:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh hi [PII], this is [PII] calling from provider's office to check on the claim status.
[AGENT][POSITIVE] All right. I'm happy to check on a claim. Do we have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, it is D.
[CUSTOMER][NEUTRAL] As in Delta 473-05915.
[AGENT][NEUTRAL] Unfortunately, [PII], I can't pull the patient with that number. Do you have a certificate number or their name or social?
[CUSTOMER][NEUTRAL] Um, is that OK if I give you the claim number? Will that be possible?
[AGENT][NEUTRAL] Yeah, I can pull up the claim number. What's that?
[CUSTOMER][NEUTRAL] It is 355-041-3.
[AGENT][NEUTRAL] Alright, let me pull that up here. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What is the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Mhm. Yes, it is [PII], and date of birth is [PII].
[AGENT][NEUTRAL] Thank you. So looks like this claim was denied stating policy provides no benefits for the charges made on an inpatient visit.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Is it non-covered charges under the patient's plan if I'm not wrong.
[AGENT][POSITIVE] Yes, yes, correct.
[CUSTOMER][NEUTRAL] May I know the patient's plan here?
[AGENT][NEUTRAL] This is a limited benefit hospital indemnity plan.
[CUSTOMER][NEUTRAL] Limited.
[CUSTOMER][NEUTRAL] Uh, it's, there's limited benefit hospital.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK, got it. And is that, uh, and is the whole amount goes to the patient responsibility here?
[AGENT][NEUTRAL] We're not able to advise patient responsibility, that's up to the provider facility.
[CUSTOMER][NEUTRAL] OK, got it. And may I have the copy of an EOP for this claim?
[AGENT][NEUTRAL] Yeah, we can send a copy. What's the fax number?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Alright. So give me about 5 minutes and then I'll be over there. Should we mark attention to anybody on this?
[CUSTOMER][NEUTRAL] Uh, no, I just, yeah, attention to claims department.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, that's on its way. Is there anything else?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yes, uh, I do have another claim. It's for, it's for the same patient with different data of service as well. Um, for this claim, uh, before that, before we move on to the next claim, I just want to check, was there any providers discount applied here or?
[CUSTOMER][NEUTRAL] Is that anything? Is that any providers?
[AGENT][NEUTRAL] Not that I see, no.
[CUSTOMER][NEUTRAL] OK, got it. Thank you so much. Yes, so I do have another claim. It's for the same patient with different data service and different bill amount. Would you mind checking that for me, please?
[AGENT][NEUTRAL] OK, just one moment here.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] What's the uh other date of service please?
[CUSTOMER][NEUTRAL] It is from [PII] with total charges of $476 even.
[AGENT][NEUTRAL] $476 even and date of service [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And [PII].
[AGENT][NEUTRAL] I'm not showing any claims on file for that billed amount of 476. Do you have any claim number?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yes, I do have a claim number which is 355-0408.
[AGENT][NEUTRAL] All right. So that claim shows that it was denied. There are no benefits provided under the patient plan.
[CUSTOMER][NEUTRAL] Mhm, got it. Is there any providers discount here?
[AGENT][NEUTRAL] Not that I see.
[CUSTOMER][POSITIVE] Got it, thank you. And may I have the copy of him he'll be here for this please?
[AGENT][NEUTRAL] Mhm. Same fax number?
[CUSTOMER][NEUTRAL] Yes, it goes for the same fax number.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And I do have another claim as well. It goes for the same patient with different data service and build amount.
[CUSTOMER][NEUTRAL] Uh, for this also goes for the same demand. I just want the copy of it here before this as well.
[AGENT][NEUTRAL] What's the claim number?
[CUSTOMER][NEUTRAL] Yeah, sure. Just a moment.
[CUSTOMER][NEUTRAL] The claim number here, it is 355-0411.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm sure.
[CUSTOMER][NEUTRAL] Uh, uh, just for small, uh, clarification, you said the patient, uh, if you said for checking the patient responsibility, it depends on the provider you mean.
[AGENT][NEUTRAL] We don't advise on patients no, we just don't advise on patient responsibility. That's up to the facility or the provider.
[CUSTOMER][NEUTRAL] To check if
[CUSTOMER][POSITIVE] Mhm. OK, got it. Thank you so much.
[AGENT][NEUTRAL] You're welcome. So the last fax is on its way to you. You should have those in the next 5 minutes. Was there anything else you need that we can check on today?
[CUSTOMER][NEUTRAL] Thank you, yeah, uh, that's it for today. And may I have the reference number, please?
[AGENT][NEUTRAL] Call reference is my name with my last initial than today's date. My name again is [PII], that's [PII] Last initial is [PII], and then today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Got it. Thank you, [PII]. Have a great day. Bye bye.
[AGENT][POSITIVE] You're welcome. Bye-bye.