AccountId: 011433970860
ContactId: bc4a4215-60f8-4c7e-8c32-fddcb31d8b5a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 870590 ms
Total Talk Time (AGENT): 174448 ms
Total Talk Time (CUSTOMER): 296219 ms
Interruptions: 6
Overall Sentiment: AGENT=1.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/bc4a4215-60f8-4c7e-8c32-fddcb31d8b5a_20250508T15:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling from provider's office, taking on a claim status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. May I please get your call back number?
[CUSTOMER][NEUTRAL] Status.
[CUSTOMER][NEUTRAL] Number
[CUSTOMER][NEUTRAL] [PII]. It is a direct line?
[AGENT][NEUTRAL] Thank you, ma'am. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] And then what is [PII]'s policy number, please?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] 02498570.
[AGENT][NEUTRAL] OK, let me look him up real quick.
[AGENT][NEUTRAL] OK, and then may I have [PII]'s date of service and charge amount?
[CUSTOMER][NEUTRAL] Uh, [PII] and bill amount is $279 even.
[AGENT][NEUTRAL] Thank you. And then what's the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Their part.
[CUSTOMER][NEUTRAL] Um, after the process.
[CUSTOMER][NEGATIVE] They're not gonna do that.
[CUSTOMER][NEUTRAL] $165.41.
[AGENT][NEUTRAL] Thank you very much, Ms. [PII], and then can you please give me the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Calling from? Medical University Hospital Authority.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I look this claim up for you, Ms. [PII], and I'll be right back.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I'll be right back. OK. You are on hold.
[AGENT][POSITIVE] Thank you, ma'am.
[AGENT][NEUTRAL] OK, we're looking.
[AGENT][NEUTRAL] 279.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you, Ms. [PII] for holding for me. I have the claim information for you.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][POSITIVE] Yes, ma'am. I'm ready for, I'm ready for the information.
[AGENT][NEUTRAL] The claim number is 35760667.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] 57. Mhm.
[CUSTOMER][NEUTRAL] 7
[AGENT][NEUTRAL] And the claim was denied because the maximum amount payable was met.
[CUSTOMER][NEUTRAL] But the claim was denied because the maximum amount payable was met.
[CUSTOMER][NEUTRAL] Uh, if you don't mind, could you please repeat the claim number? 35,760?
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, 606-7.
[CUSTOMER][NEUTRAL] 6067. OK.
[CUSTOMER][NEUTRAL] Maximum amount is reached.
[CUSTOMER][NEUTRAL] Uh, it is in the patient responsibility.
[AGENT][NEUTRAL] We do not give patient responsibility we let the providers determine that.
[CUSTOMER][NEUTRAL] Not give patients responsibility but the providers determine that.
[CUSTOMER][NEUTRAL] Maximum, uh, OK. You said it is the maximum benefit exist.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] The maximum benefit, uh, under the patient plan, right?
[AGENT][POSITIVE] Correct, yes, ma'am.
[CUSTOMER][NEUTRAL] Correct, yeah. OK, if it is maximum benefit, uh, reached under patient plan means, uh, we can build the patient, right?
[AGENT][NEUTRAL] We don't give that information that's determined by the provider.
[CUSTOMER][NEUTRAL] We don't give that information that's determined by the providers.
[CUSTOMER][NEUTRAL] OK. Otherwise, it is a uh provide a discount?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] We need to adjust the amount?
[AGENT][NEUTRAL] We don't give discounts that's determined by the provider.
[CUSTOMER][NEUTRAL] Then how?
[CUSTOMER][NEUTRAL] We don't give discounts that's determined by the provider.
[CUSTOMER][POSITIVE] OK, give me a few minutes. One minute, let me check the, check the information. Thank you so much.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Mm thank you for being online, ma'am.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] You, yeah, uh, you said it is, uh, may I know the patient plan type?
[AGENT][NEUTRAL] Yes, it's Medlink.
[CUSTOMER][NEUTRAL] Yes, this is Medley.
[CUSTOMER][NEUTRAL] But like,
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It is like HMO PP or EPO?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] It's a secondary.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's a secondary.
[CUSTOMER][NEUTRAL] OK. And the patient plan benefit was exist. How many units or dollar amount is allowable for the service?
[AGENT][NEUTRAL] Let me check for you.
[AGENT][NEUTRAL] It and this is just to verify benefits, it's not a guarantee of payment.
[CUSTOMER][NEUTRAL] And this is just to verify benefits. It's not a guaranteed payment.
[AGENT][NEUTRAL] It is $1000.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] $1000 is allowable for the service, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It is for a calendar year or uh
[AGENT][NEUTRAL] It's for per occurrence and per occurrence has to be separated by 90 days.
[CUSTOMER][NEUTRAL] For per occurrence per occurrence has to be separated by 90 days.
[CUSTOMER][NEUTRAL] Uh, sorry, come again, what?
[AGENT][NEUTRAL] It's per occurrence and per occurrence has to be separated by 90 days.
[CUSTOMER][NEUTRAL] With occurrence.
[CUSTOMER][NEUTRAL] And per occurrence has to be separated by 90 days.
[CUSTOMER][NEUTRAL] Um, that means it is allowable for, uh,
[CUSTOMER][NEUTRAL] Plan here, right?
[CUSTOMER][NEUTRAL] $1000 is allowable for a plan year.
[AGENT][NEUTRAL] Yes, the benefit amount is $1000.
[CUSTOMER][NEUTRAL] Yes, the benefit amount is $1000. OK. $1000 is, OK. When it was reached?
[AGENT][NEUTRAL] Let me check.
[AGENT][NEUTRAL] I cannot give that information that it's a different facility.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I cannot get that information. That's a different facility.
[CUSTOMER][NEUTRAL] OK. Uh, ma'am, uh, do you have a UOB with a patient responsibility?
[AGENT][NEUTRAL] No, we do not give patient responsibility, but I can send you an EOB.
[CUSTOMER][NEUTRAL] No, we do not give patient responsibility, but I can send you an EOB. OK.
[AGENT][NEUTRAL] What is your fax number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 999
[CUSTOMER][NEUTRAL] [PII]. Attention to [PII].
[AGENT][NEUTRAL] OK, alright, Miss [PII], I'm gonna put you on a quick hold while I get this fax ready for you and I will be right back.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, [PII]. I have that EOB on its way to you now.
[CUSTOMER][NEUTRAL] For me, I have that POB on now. OK.
[CUSTOMER][NEUTRAL] Uh, ma'am, for a future reference, uh, APL have a provider portal?
[AGENT][POSITIVE] Yes, we have a portal.
[CUSTOMER][NEUTRAL] Yes. Yes.
[AGENT][NEUTRAL] Would you like the um address to it?
[AGENT][POSITIVE] It's secured [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Yes. Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, if I, if we get the access means, what information we need to enter into the, to get the claim information?
[AGENT][NEUTRAL] You'll need to enter the tax ID number and your patient account number.
[CUSTOMER][NEUTRAL] You'll need to enter the tax ID number and your patient account number. OK.
[CUSTOMER][NEUTRAL] OK. When I receive the EOP ma'am?
[AGENT][NEUTRAL] It's on its way.
[CUSTOMER][NEUTRAL] OK. Can I get the call reference number?
[AGENT][NEUTRAL] Yes, ma'am. You can use my name [PII] and today's date.
[CUSTOMER][NEUTRAL] My name's [PII] and today's date.
[CUSTOMER][POSITIVE] Thank you so much. Have a great day. Bye-bye. Take care.
[AGENT][POSITIVE] You too, Ms. [PII]. That's everything I can help you with today.
[CUSTOMER][POSITIVE] [PII], that's everything I can help you with today. Yeah.
[AGENT][POSITIVE] OK, well, you have a wonderful day and thank you for calling APL.
[CUSTOMER][POSITIVE] OK, well you have a wonderful day and thank you for calling APL.
[CUSTOMER][NEUTRAL] Bye-bye.