AccountId: 011433970860
ContactId: bfe080ab-12ea-46a7-a001-3f502f64ed3f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 703609 ms
Total Talk Time (AGENT): 311456 ms
Total Talk Time (CUSTOMER): 209799 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/bfe080ab-12ea-46a7-a001-3f502f64ed3f_20250217T16:11_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Hello, my name is [PII] and I'm calling you from the provider's office. Uh, would you know the status of a claim?
[AGENT][NEUTRAL] I can assist you with claim status. You said your name was [PII]?
[CUSTOMER][NEUTRAL] Uh, let me spell it out for you. It is [PII], and initial of
[AGENT][NEUTRAL] Um, you did break up. What was the initial?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] You was breaking up. What was the initial you said?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, um, your end is breaking up, so, um, I can assist you today with claim status. Can I please have a um callback number for you please?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] May I have your policy number, please?
[CUSTOMER][NEUTRAL] 0197.
[CUSTOMER][NEUTRAL] 2970.
[AGENT][POSITIVE] Thank you for that one moment please while I pull up the policy.
[AGENT][NEUTRAL] May I please have the member's name and date of birth?
[CUSTOMER][NEUTRAL] And can you please spell out your name?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] And the day will be is [PII].
[AGENT][NEUTRAL] Thank you so much for verifying that information today, you're calling for claim status. Could you please verify the date of service that you're calling about today?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] Charge amount?
[CUSTOMER][NEUTRAL] Wait, please. It is $250.09.
[AGENT][NEUTRAL] One moment please.
[CUSTOMER][NEUTRAL] Can you please spell out your name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] 199.
[AGENT][POSITIVE] Wow.
[AGENT][NEUTRAL] it's 499.
[AGENT][NEUTRAL] Could you please um tell me what the um
[AGENT][NEUTRAL] The provider
[AGENT][NEUTRAL] Um, the, is it Beacon Respiratory Services? Um, could you tell me the name of the.
[AGENT][NEUTRAL] Location
[CUSTOMER][POSITIVE] Yes, yes, yes. Correct.
[AGENT][NEUTRAL] That is the location?
[CUSTOMER][NEUTRAL] Uh, what's the location? Uh, can you repeat?
[AGENT][NEUTRAL] Could you tell me the location? What is the provider's?
[CUSTOMER][POSITIVE] OK, OK, OK. I'm sorry, I'm sorry, I'm sorry.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Beacon Respiratory Services.
[AGENT][NEUTRAL] OK. I just wanna make sure I have the correct um information because we do have a claim, um.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] In-house, OK, so we did receive this claim on [PII], [PII]. It was processed on [PII].
[AGENT][NEUTRAL] And one moment please while I get you that denial reason.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so it looks like um.
[AGENT][NEUTRAL] All their um benefits applied to the deductible. They had a deductible with this policy, so all of their benefits applied to the deductible.
[CUSTOMER][NEUTRAL] Uh, what's the total amount? Can you tell me?
[AGENT][NEUTRAL] Can I tell you what now?
[CUSTOMER][NEUTRAL] Uh, what's the total allowed amount which is to allowed towards deductibles?
[AGENT][NEUTRAL] Total allowed amount.
[AGENT][NEUTRAL] Um, the allowed amount that you, they have on here.
[AGENT][NEUTRAL] I'm not understanding your question. Are you asking me what you, what you bill for? I'm, I'm.
[CUSTOMER][NEUTRAL] Uh, uh, I, how many, how much, uh, uh.
[CUSTOMER][NEUTRAL] No, no, no. Uh, again, how much amount or how many dollars are
[CUSTOMER][NEUTRAL] Patients responsibility or
[CUSTOMER][NEUTRAL] Insurance allowed as deductibles for this claim.
[AGENT][NEUTRAL] OK, so on the EOB that you all submitted, the deductible, it says 19238. That is the allowed amount here on your deductible on your EOB. Is that what you're asking about what your EOB states?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK, but that's what.
[CUSTOMER][NEUTRAL] Uh, I, I'm not my A will be, uh, I.
[AGENT][NEUTRAL] Are you asking what is the deductible that APL has for, are you asking about what our deductible is, what deductible the member has with APL?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] No, no, no, no.
[AGENT][NEUTRAL] OK, so I'm not understanding what you need.
[CUSTOMER][NEUTRAL] No, no, no, no. Actually, uh, I just want, want to ask how much, how much, how much insurance paid for this? Or how much, how many deductibles insurance allow for this or paid for this thing?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Kind of.
[AGENT][NEUTRAL] Uh, let me, I'm gonna transfer you over to um the supplemental cause maybe they can understand, um, I guess because I'm not familiar. I'm not sure what you're asking. So I'm, I'm gonna ran.
[CUSTOMER][NEUTRAL] Uh, no, no, uh, that's, it's not uh confusing, yeah.
[AGENT][NEUTRAL] I'm gonna
[CUSTOMER][NEUTRAL] Actually, uh 00, wait, please, wait, please.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Wait, please. Uh, actually, that my question is,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What's the, what, how much or how many dollars you allow deductibles. You said you said that uh the payment or the pay, the amount is allowed towards deductibles, taking responsibility, right?
[AGENT][NEUTRAL] Yeah, whatever, whatever you bill for of the, you, you build and said we were responsible for.
[CUSTOMER][NEUTRAL] You said that?
[CUSTOMER][NEUTRAL] The claim process the deductibles.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 19238.
[AGENT][NEUTRAL] And we denied it letting you know that all payable benefits were applied to the policy deductible.
[CUSTOMER][NEUTRAL] OK. That's, that's, that's.
[AGENT][NEUTRAL] So I can
[CUSTOMER][NEUTRAL] OK, so that's not a denial, that's the patient responsibility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So there is uh there's no denial reason, right? There's only a deductible amount.
[AGENT][NEUTRAL] That is the
[AGENT][NEUTRAL] That is the reason why we didn't pay, is because it applied to the member's deductible.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh, OK. Give me a minute, please.
[CUSTOMER][NEUTRAL] So how do you get?
[CUSTOMER][NEUTRAL] Uh, uh, ex, try that, uh, you do didn't cover the, uh, primary deductibles kind of thing.
[AGENT][NEUTRAL] OK. So, sir, I'm gonna transfer you because I work in the cancer queue.
[AGENT][NEUTRAL] If you are calling on claim status, something that I can do. I've told you what we have, you're asking questions I'm not familiar with, so I'm gonna transfer you to the supplemental area and they can assist you further. OK, one moment please.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] OK. Before that, OK, OK, OK. Before that, OK, can you please provide me call reference number before that?
[AGENT][NEUTRAL] They can provide you with the call reference number because they're going to continue the call, but my name is [PII], it's [PII] like the month, and talking to me, it would be my name and today's date. I'm going to transfer you over to supplemental so they can assist you with the deductibles and all of how that applies because I work in the cancer department, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So one moment, please.
[CUSTOMER][POSITIVE] Sure, sure, sure. No worries. Thank you so much. Thank you so much.
[CUSTOMER][NEUTRAL] Referring.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] [PII], this is [PII] in the cancer queue. Um, I have, uh, policy 1,972,970.
[AGENT][NEUTRAL] This is a provider. I'm gonna spell you his name. I don't know how to pronounce it.
[AGENT][NEUTRAL] He said it's [PII]
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] He's calling on claim 35.
[AGENT][NEUTRAL] 52
[AGENT][NEUTRAL] 649.
[AGENT][NEUTRAL] Where the benefits were applied to the member's deductible.
[AGENT][NEUTRAL] I've explained to him that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] He's asking about family plans, what was applied. He was asking stuff I really don't know. So I'm transferring the call, OK?
[CUSTOMER][NEUTRAL] OK, I'm sorry, I'm sorry. Before you do that, I'm sorry who are you now? I'm so sorry. I didn't, I didn't get that part.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, [PII] OK and the provider's name if you could spell that for me one more time your phone was breaking up [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, did you get a callback number [PII]?
[AGENT][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] OK, he's calling in regards to [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK alright thank you so much.
[AGENT][NEUTRAL] Mhm.