AccountId: 011433970860
ContactId: bca77752-f126-4780-bf29-3e61c71ec8b8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 644340 ms
Total Talk Time (AGENT): 147926 ms
Total Talk Time (CUSTOMER): 153028 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/bca77752-f126-4780-bf29-3e61c71ec8b8_20250206T16:10_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from Blessing Hospital. I have a member that came to our facility that they have this, this is listed as their secondary insurance, and I'm trying to check my claim status if I could please.
[AGENT][NEUTRAL] OK, I can help you with claim status, Ms. [PII]. um, can I please get your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Sure, my callback number is [PII]. Direct extension is [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then what is the patient's name?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Last name is [PII]
[CUSTOMER][NEUTRAL] His date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you ma'am and then what is [PII]'s policy number?
[CUSTOMER][NEUTRAL] Um, it is listed as 0213.
[CUSTOMER][NEUTRAL] 862 8
[AGENT][NEUTRAL] OK, let me look up that policy real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and then what is the data service?
[CUSTOMER][NEUTRAL] 318 2024.
[AGENT][NEUTRAL] And the charge amount please?
[CUSTOMER][NEUTRAL] Um, let me go back.
[CUSTOMER][NEUTRAL] Well, it looks like it went through primary insurance first and um that, that the original bill amount was 15, 1,51155 cents. It looks like after adjustments and payments from Blue Cross, which is primary, it left a balance of
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, let me go back, sorry.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] It left a balance of 73472.
[AGENT][NEUTRAL] OK, and then you said you were calling from Blessing's Hospital, is that correct?
[CUSTOMER][POSITIVE] Yes ma'am, yes ma'am.
[AGENT][NEUTRAL] OK, alright, Miss [PII] I'm gonna put you on a brief hold while I look up this claim for you and I will be right back.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi Ms. [PII], this is [PII]. So looking on the data service of [PII] for Blessings Hospital, I do find a claim that was submitted. Um, the claim number is 3484588.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 34.
[CUSTOMER][NEUTRAL] And that was that was 348458. Can you hear me? The claim number is 3484588.
[AGENT][NEUTRAL] And I do show.
[AGENT][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] Yes, that's correct, um, it doesn't match the amount that you gave me I show that we had.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I after I looked at that there looks like there was a $100 payment on there, um, so it should have been $800 and something instead, OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, we did pay $100 with check number 1864455.
[CUSTOMER][NEUTRAL] You said once you check number 168.
[AGENT][NEUTRAL] No, no, 186.
[AGENT][NEUTRAL] 4455.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then let me see what the remarks are.
[CUSTOMER][NEUTRAL] Yeah, because I don't know what the remaining 700 if that's a write-off, that should be patient responsibility.
[AGENT][NEUTRAL] Right, so after that check was paid, the calendar year maximum for the outpatient office visits due to sickness or accident was met for the calendar year.
[CUSTOMER][NEUTRAL] OK, so again, is that balance patient responsibility? I don't have an EOB for it for what you guys paid, so I don't know what to do with that remain that remaining balance. So, I mean.
[AGENT][NEUTRAL] I can
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] So what I'm asking you is that.
[AGENT][NEUTRAL] I can give you
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] I can send you a copy of the EOB if you can give me your fax number. I'll fax it over to you, but we don't give.
[CUSTOMER][NEUTRAL] You know, it's I, I, I work.
[CUSTOMER][NEUTRAL] I, I work remotely, so I'm not, that's gonna go to a completely different location. Um, you can email it to me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK and we do not give patient responsibility because that's determined by a provider?
[AGENT][NEUTRAL] Um, but I can. What is your email address?
[CUSTOMER][NEUTRAL] Sure, it's [PII]
[CUSTOMER][NEUTRAL] At [PII], all one word.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] Yeah, unfortunately with us working remote it'll go to a thing and then it gets scanned in so it could be weeks before I ever it ever arrives to me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, alright, Ms. [PII], OK, so I'm gonna put you on a hold while I pull up this um.
[AGENT][NEUTRAL] Uh, EOB for you and get it on its way. It's gonna be a hold while I get the email together.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] All right, thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Hi [PII], thank you so much for holding for me. I did find the claim and I have sent it through email to you.
[CUSTOMER][POSITIVE] OK. That sounds great. I do appreciate it.
[AGENT][POSITIVE] You're very welcome. Is there anything else I can help you with before we go?
[CUSTOMER][POSITIVE] No, you've been great. I appreciate it I appreciate getting that sent over and emailing it to me so that I can get that taken care of.
[AGENT][POSITIVE] Yes ma'am, I hope you have a great day, Ms. [PII], and thank you for calling APO.
[CUSTOMER][POSITIVE] Thank you you as well.
[AGENT][NEUTRAL] Bye-bye, ma'am.
[CUSTOMER][NEUTRAL] Mhm bye bye.