AccountId: 011433970860
ContactId: b9dd9ef5-da3c-49e3-9572-5ea1faec714d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1487280 ms
Total Talk Time (AGENT): 323107 ms
Total Talk Time (CUSTOMER): 484894 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/b9dd9ef5-da3c-49e3-9572-5ea1faec714d_20250516T19:58_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII], and I'm calling for Bath County Memorial Hospital. I verified the way this call is made for additional information about the I. Please note the call will be monitored and recorded for quality and training purposes. And uh could you please spell your name for me?
[AGENT][NEUTRAL] Yes, my name is [PII] And what is your name? Can you spell it?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, [PII], what is your callback number just in case the call is disconnected?
[CUSTOMER][NEUTRAL] Callback number is [PII] and that is a direct line.
[AGENT][NEUTRAL] Thank you. And then what is the.
[AGENT][NEUTRAL] Patient's name, date of birth, and policy number.
[CUSTOMER][NEUTRAL] [PII], date of birth is [PII]. Policy number 01835963.
[AGENT][NEUTRAL] OK, let me pull that up real quick.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And may I have the date of service for [PII] and the charge amount?
[CUSTOMER][NEUTRAL] [PII], but the amount is $168. I'm sorry, just a moment, please.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] Thank you. And yes, the bill amount that is $187 even.
[AGENT][NEUTRAL] OK, and then what are the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, just a moment please.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Actually, they have processed.
[CUSTOMER][NEGATIVE] This as deductible, they have not paid any amount.
[CUSTOMER][NEUTRAL] For this plane?
[AGENT][NEUTRAL] OK, so what is the, the balance?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] That is
[CUSTOMER][NEUTRAL] $168.86.
[AGENT][NEUTRAL] OK thank you and then may I please have the facility that you're calling from?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Bates County Memorial Hospital.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and you said this was already denied what is the claim number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, the claim number that is 359-879-5.
[AGENT][NEUTRAL] OK, Ms. [PII], I'm gonna put you on a quick hold while I look up this claim information and I'll be right back with you.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 987
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, Ms. [PII]. I've got the claim information pulled up for you.
[AGENT][NEUTRAL] And it is claim number 359-8795. This is the remark that is on the claim.
[AGENT][NEUTRAL] Benefits payable under this certificate are limited to those outlined on the schedule of benefits. This is not a covered loss.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm sorry, your voice is breaking off. I'm sorry.
[CUSTOMER][NEGATIVE] I'm sorry, your voice is breaking off.
[AGENT][NEUTRAL] OK, under the
[AGENT][NEUTRAL] Under the patient's plan this is not a covered loss. Therefore no amount is payable for this expense.
[CUSTOMER][NEUTRAL] OK. So the, this uh procedure code was not covered under the member's plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] But I do see that we have received the payment for the same procedure code on the different date of service.
[AGENT][NEUTRAL] Uh, you can correct the claim or you can appeal, but that's what the claims specialist said that the pros that this is not a covered loss under the patient's plan.
[CUSTOMER][NEUTRAL] OK. And uh I do have the date of service and the amount for the claim that we have received the payment. Are you able to send this claim back for reprocess for that reason?
[AGENT][NEUTRAL] I'm sorry, I didn't understand the question. Can you repeat it?
[CUSTOMER][NEUTRAL] Yes, I'm sorry. So, uh, I do have the date of service and bill amount under the claim that we have received the payment for the same procedure code. So, are you able to send this claim back for the process with that reason?
[AGENT][NEUTRAL] Under this claim that you're calling about it the procedure code is under facility.
[AGENT][NEUTRAL] And this claim is
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Non-covered
[AGENT][NEUTRAL] With the procedure code of facility.
[CUSTOMER][NEUTRAL] OK. I, yes, I understand that, but we have received the payment for the same procedure code on the different date of service.
[AGENT][NEUTRAL] What was the claim number?
[CUSTOMER][NEUTRAL] OK. Yes, the claim number that is going to be.
[CUSTOMER][NEUTRAL] 356-911-9
[AGENT][NEUTRAL] OK, let me look that up.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Mhm thank you.
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You can appeal it if you would like to appeal it. Um, you have 180 days from the date the claim was processed.
[AGENT][NEUTRAL] And you'll need to send a letter Y your.
[AGENT][NEUTRAL] Wanting to appeal.
[CUSTOMER][NEUTRAL] So, you're unable to send back for the process?
[AGENT][NEUTRAL] Yes, you can appeal it and then it would be reprocessed.
[CUSTOMER][NEUTRAL] Just a moment, please.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] All right. And you're unable to send this claim back for reprocess and the timely filing limit for submitting an appeal is 180 days from the last process date and the mailing address I have is [PII]. Correct?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] That's the claims address that you have, was, what was it again, ma'am?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No ma'am, let me give you our claims address.
[CUSTOMER][NEUTRAL] Yes, please. Mhm.
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And that's in [PII], [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Thank you. And the [PII], correct?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] And your name again, that is [PII], I'm sorry.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Last, uh, last name initial is?
[AGENT][NEUTRAL] A
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] Thank you and uh just a moment please.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome, take your time.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And also, could you please provide me the reference number for this one? And I do have 2 more claims. Could you please help me with those two as well?
[AGENT][NEUTRAL] Yes, ma'am. What is, um, I'm sorry, the reference number for all of them will be my name and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the next member's name?
[AGENT][NEUTRAL] Date of birth and policy number?
[CUSTOMER][NEUTRAL] All right. Just a moment, please.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 2025. All right. The next member ID that is
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 02337082
[CUSTOMER][NEUTRAL] [PII] as in [PII] as in [PII], number [PII]. And the member name that is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] OK, let me look up that policy.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and then what is the data service and the charge amount?
[CUSTOMER][NEUTRAL] Date of service is [PII]. And the bill amount is
[CUSTOMER][NEUTRAL] $72.27 and the balance amount.
[CUSTOMER][NEUTRAL] $50 even.
[AGENT][NEUTRAL] OK. And is it for the same facility?
[CUSTOMER][NEUTRAL] OK. No.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh, just a moment please. I just need to verify it.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] No, it's different.
[AGENT][NEUTRAL] What is the facility name please?
[CUSTOMER][NEUTRAL] Cardiovascular Medicine Associates, PA.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold again, Ms. [PII], while I look up this claim and I'll be right back.
[CUSTOMER][NEUTRAL] Hello
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me, Ms. [PII]. looking on data service of [PII], I do not find a claim on file for the amounts that you have given me.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, the bill amount was $72.27.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] You have no bill on file. Uh, I'll try. I do have the claim number. Shall I proceed that? Oh, actually, it was $260 even, right? Do you have that one?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh no, that's not the that's not the number you gave me.
[AGENT][NEUTRAL] You gave me $72.27.
[CUSTOMER][NEUTRAL] OK. Yeah, I
[CUSTOMER][NEUTRAL] Yes, I have verified here. Uh, I do apologize for that one. And the bill amount is $260 even, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, alright, let me relook I'm gonna put you on a quick hold I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, Ms. [PII], I've got it pulled up for you. Uh, the claim number is 359.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 8507.
[AGENT][NEUTRAL] And the claim has been denied because office visits are not covered under the patient's plan.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK just a moment please.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Offices is not covered as for the patient's plan.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And see and all.
[CUSTOMER][POSITIVE] Hello, I'm sorry.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Can you hear me?
[AGENT][NEUTRAL] I can hear you. Yes, ma'am.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Reference number is the same, right? All right. And uh shall I proceed the last one?
[AGENT][NEUTRAL] Yes, ma'am, can you give me the name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] To be
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] OK. The policy number is 02467711. And the member name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, let me pull up that policy for us real quick.
[AGENT][NEUTRAL] OK, and then what's [PII]'s data service and charge amount?
[CUSTOMER][NEUTRAL] The amount that, OK. The date of service is [PII] and the bill amount, that is, just a moment.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] That, uh-huh, that is $495 even.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And then after primary, what's the amount?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] $388.21.
[CUSTOMER][NEUTRAL] And this is also 499214.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] OK, and what is the name of the facility?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Endocrinology Associates, PA.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold. I'm gonna look up this claim for us and I'll be right back, Miss [PII].
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, Miss [PII]. I've got this claim ready for you.
[AGENT][NEUTRAL] The claim number is 359-852-4.
[AGENT][NEUTRAL] The claim was paid $51.79 with check number [PII] on [PII].
[AGENT][NEUTRAL] Are you there Ms. [PII]?
[CUSTOMER][NEUTRAL] Yes, I'm sorry. Uh, this is for the code 99214.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] 99214 is an office visit and office visits are not covered under the patient's policy procedure 952-51 was paid $51.79.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] All right. And yes, thank you so much for your assistance and have a great day. Bye for now.
[AGENT][POSITIVE] You too, Ms. [PII]. That's everything I can help you with today?
[CUSTOMER][NEUTRAL] OK. Mhm, yes.
[AGENT][POSITIVE] Alright well you have a good weekend and thank you for calling APL bye bye ma'am.
[CUSTOMER][POSITIVE] Thank you.