AccountId: 011433970860
ContactId: bd69272d-7572-4145-b656-46532f756297
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 387700 ms
Total Talk Time (AGENT): 192898 ms
Total Talk Time (CUSTOMER): 94878 ms
Interruptions: 0
Overall Sentiment: AGENT=2, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/bd69272d-7572-4145-b656-46532f756297_20250106T14:56_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] This is [PII] with Valid Health Medical Associates. I have a claim I need to check status on, please.
[AGENT][POSITIVE] It would be my pleasure to help you with that claim status, [PII]. What is a good callback number?
[CUSTOMER][NEUTRAL] Direct line [PII].
[AGENT][POSITIVE] Thank you, [PII]. And the policy number for the patient.
[CUSTOMER][NEUTRAL] It is 02510281.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please, [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And [PII] [PII].
[AGENT][POSITIVE] Thank you, and it would be my pleasure to help you the claim status. What is the date of service?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] It was for [PII] and total charge was $295.
[AGENT][NEUTRAL] All right, thank you. And then get checking on that. And what was the facility name?
[CUSTOMER][NEUTRAL] It's um Valid Health Medical Associates and [PII] is the doctor on the claim.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] I do see we've received that claim. Let me get that received date for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We received that claim.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] And processed on [PII].
[AGENT][NEUTRAL] And it was denied because the calendar year maximum for outpatient office visits due to sickness and or accident has been met for the calendar year.
[CUSTOMER][NEUTRAL] bigger max for out office visits.
[AGENT][NEUTRAL] So their benefit was maxed out for 2024.
[AGENT][NEUTRAL] Benefits do renew in January in [PII] every year.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Would you like a claim number, [PII]?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] The claim number is 352.
[AGENT][NEUTRAL] 9603.
[CUSTOMER][NEUTRAL] So on this one since it was max benefit then the patient owes the 295 correct.
[AGENT][NEUTRAL] So we're not major medical, any billing of the patient would be determined by the provider.
[CUSTOMER][NEUTRAL] Can you fax me a copy of your old EOV?
[AGENT][NEUTRAL] We actually have a provider portal.
[AGENT][POSITIVE] At [PII] and that's [PII]. It's actually quicker to get it from there and if you need, if you don't have an account, I can assist you create an account real quick.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK, so it's [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you go there you go in as a new user.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And then you're going to um choose the last option, your medical or dental provider.
[AGENT][NEUTRAL] And then you're just gonna put in your tax ID number.
[AGENT][NEUTRAL] And the patient's account number listed in box 26 on the HIPA and I can provide that patient account number for you so you don't have to look it up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Whenever you're ready.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] just a second.
[CUSTOMER][POSITIVE] OK, I'm ready.
[AGENT][NEUTRAL] Patient's account number is P as in potatoes 288.
[AGENT][NEUTRAL] 022.
[AGENT][NEUTRAL] 440.
[CUSTOMER][NEUTRAL] And then I just click next.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then it'll ask you to create a login and password or username and password.
[CUSTOMER][POSITIVE] Perfect. And then once I create it I can just go in and look at their claim and get the EOB.
[AGENT][NEUTRAL] That's right. There's gonna be two options. There'll be an option if you have a claim number that's gonna be your first option. You just put in the name, um.
[AGENT][NEUTRAL] And claim number it may may ask for the date of birth, um, and it'll pull up the EOB. If you don't have a claim number, then there's option 2, and you can use that. You will have to have the last 4 of the policyholder social to do option 2.
[AGENT][NEUTRAL] But it will download your EOD.
[CUSTOMER][NEUTRAL] you say our claim number is
[CUSTOMER][NEUTRAL] The claim number is 3529603 correct.
[AGENT][POSITIVE] Yes, yes, ma'am, and you'll have that EOB immediately instead of having to wait for a fax. It's a lot easier and quicker.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. I will go. Yes, I will go on there and do that. And do you have a call reference I can put on my note for today, please?
[AGENT][NEUTRAL] Hm, it is.
[AGENT][NEUTRAL] Sure. Call reference number is my name and today's date, and I spell my name [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][POSITIVE] It's been a pleasure to assist you with that claim status, [PII]. Thank you for calling.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Thank you so much for all your help.
[AGENT][POSITIVE] My pleasure and thank you for calling APL. I hope you have a lovely day.
[CUSTOMER][POSITIVE] Thanks you too.
[AGENT][POSITIVE] Stay warm wherever you are, it's cold, so stay warm.
[CUSTOMER][POSITIVE] Thank you. Yes, thank you.
[AGENT][POSITIVE] You're welcome. Take care. Bye-bye.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Bye bye.