AccountId: 011433970860
ContactId: c3bcae85-03eb-4b3e-84df-33630960c3ac
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 777200 ms
Total Talk Time (AGENT): 243434 ms
Total Talk Time (CUSTOMER): 199929 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/c3bcae85-03eb-4b3e-84df-33630960c3ac_20250217T15:50_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII]. I'm calling from provider office regarding claim status.
[AGENT][NEUTRAL] OK, I can verify claim status for you and I'm sorry, your name is again?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and what is that policy number, please?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Sure. It's uh
[CUSTOMER][NEUTRAL] 0241
[CUSTOMER][NEUTRAL] 3470 M for Mike, L for Lima, 8.
[AGENT][NEUTRAL] OK, thank you. And uh do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Uh, uh, it's [PII].
[AGENT][NEUTRAL] I apologize. What is that area code again?
[CUSTOMER][NEUTRAL] You want the area code, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, give me a moment.
[CUSTOMER][NEUTRAL] It's um
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] No, that's the zip code. No, give me uh the callback number again. I'm sorry.
[CUSTOMER][NEUTRAL] OK. [PII].
[AGENT][NEUTRAL] No, sir, just give, just give me the full uh callback number.
[CUSTOMER][NEUTRAL] Do you want a callback number?
[CUSTOMER][NEUTRAL] OK. It's [PII].
[AGENT][NEUTRAL] OK. Thank you. And verify the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, date of birth?
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] OK, and what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] Yeah, it's uh [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And um bill amount is $2180 even.
[AGENT][NEUTRAL] OK, and what is the balance after primary insurance is processed the claim?
[CUSTOMER][NEUTRAL] Balance, uh,
[AGENT][NEUTRAL] Yeah, this is a secondary policy. So do you have a balance after primary insurance is processed the claim?
[CUSTOMER][NEUTRAL] Uh, it's a $50.
[CUSTOMER][NEUTRAL] Even
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, one moment. And while I'm looking at claim information, just to let you know we do have an online service center where providers can check claim status as well as print out the EOB. That site is at secured. [PII].
[AGENT][NEUTRAL] And what's the name of the provider's office you're calling from?
[CUSTOMER][NEUTRAL] Yeah, it's Holy Cross Hospital.
[AGENT][NEUTRAL] OK, I'm showing that claim processes the outpatient benefit has maxed for the calendar year.
[CUSTOMER][NEUTRAL] OK, uh, what was the claim status for this number?
[AGENT][NEUTRAL] As I stated, the claim processed as outpatient benefit has maxed for the calendar year.
[CUSTOMER][NEUTRAL] OK. Uh, could you repeat again clearly?
[AGENT][NEUTRAL] The claim processed as the outpatient benefit has maxed for the calendar year.
[CUSTOMER][NEUTRAL] OK, the claim, claim in process, right?
[AGENT][NEUTRAL] No, the claim had processed as the benefits of max for the calendar year.
[AGENT][NEUTRAL] Meaning they have a set amount that's pay for uh payable for outpatient and they've already met that max, so there's nothing that's payable on the claim.
[CUSTOMER][NEUTRAL] OK, already our primary, uh, insurance already paid, right?
[AGENT][NEUTRAL] They have met their outpatient benefit with our company. As I stated, there's a max that we pay for outpatient and the patient has already met that max. So there's nothing for us to pay because they've met their benefit that is per their policy per calendar year.
[CUSTOMER][NEUTRAL] OK, uh, I want to know everything. Could you repeat again please slowly? I want to note it.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] The patient has a benefit that's payable for outpatient.
[CUSTOMER][NEGATIVE] Slowly slow now.
[AGENT][NEUTRAL] The patient has, sir.
[CUSTOMER][NEUTRAL] [PII], the patient has.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Patient has.
[AGENT][NEUTRAL] A max benefit that is payable for outpatient and this claim processed as the outpatient benefit has maxed for the calendar year.
[CUSTOMER][NEUTRAL] Max
[CUSTOMER][NEUTRAL] Your, uh, still very fast we can't understand and so that's why I'm noting everything. You're something our always in and out.
[CUSTOMER][NEUTRAL] The patient has maximum.
[AGENT][NEUTRAL] The patient has max benefit that is payable, but they have met their outpatient benefit. Sir, I'm sorry.
[CUSTOMER][NEUTRAL] Benefits?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Ma, hold on.
[CUSTOMER][NEUTRAL] Yes, hold on. Actually, uh, voice is no no just slowly. The uh the patient has maximum benefit payable after.
[AGENT][NEUTRAL] The claim process as.
[CUSTOMER][NEUTRAL] The claim process.
[AGENT][NEUTRAL] S
[AGENT][NEUTRAL] The outpatient.
[CUSTOMER][NEUTRAL] Claim process.
[AGENT][NEUTRAL] Benefit
[CUSTOMER][NEUTRAL] And the
[CUSTOMER][NEUTRAL] Outpatient benefits.
[AGENT][NEUTRAL] Hamax
[CUSTOMER][NEUTRAL] As maximum, right?
[AGENT][NEUTRAL] Has Max for the calendar year.
[CUSTOMER][NEUTRAL] Max for calendar year.
[AGENT][NEUTRAL] For the calendar year.
[CUSTOMER][NEUTRAL] OK. That's it.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, uh
[CUSTOMER][NEUTRAL] What's your name?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] I'm asking your name.
[AGENT][NEUTRAL] My name is [PII], last [PII] [PII].
[CUSTOMER][NEUTRAL] Yeah, actually, um.
[CUSTOMER][NEUTRAL] OK, we let, we will.
[CUSTOMER][NEUTRAL] Give me one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I still don't have any UB also.
[AGENT][NEUTRAL] I'm sorry, say again.
[CUSTOMER][NEUTRAL] I don't have any UOB also for this claim. Is there any EOB for this claim?
[AGENT][NEUTRAL] Is there any, I'm not understanding what you're saying. Is there any what?
[CUSTOMER][NEUTRAL] Uh, yeah, explanation of benefits.
[AGENT][NEUTRAL] Yes, the claim processed on [PII] and it was mailed out. As I stated previously, we do have an online service center where providers can check claim status as well as print out the EOB. Would you like to have that site?
[CUSTOMER][NEUTRAL] OK. Our process is done [PII].
[AGENT][NEUTRAL] 7th.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Is there any received it?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What is the uh status for this claim?
[AGENT][NEUTRAL] Sir, I just explained it to you several times.
[CUSTOMER][NEUTRAL] OK, OK. OK. Yeah, I already, I noted everything.
[CUSTOMER][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I miss there, uh, please let me hold on one minute.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, actually, uh, I checked in the total, uh, members details, so please let me hold on 2 minutes for this plan.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You don't.
[CUSTOMER][NEUTRAL] Thank you for uh being on hold.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] May I know for the calendar year uh calendar year for how many dollars is allowed for those?
[CUSTOMER][NEUTRAL] Pa
[AGENT][NEUTRAL] Um, the insured has an outpatient benefit up to $1250 per calendar year.
[CUSTOMER][NEUTRAL] 1,
[CUSTOMER][NEUTRAL] 1200
[AGENT][NEUTRAL] $50 per calendar year.
[CUSTOMER][NEUTRAL] Academic year.
[AGENT][NEUTRAL] Mhm, per calendar year.
[CUSTOMER][NEUTRAL] For [PII]r year.
[CUSTOMER][NEUTRAL] Give me one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, uh,
[CUSTOMER][NEUTRAL] May I know what I know, uh, may I know for which date of service patient has completed, has his uh maximum benefits?
[AGENT][NEUTRAL] No, I can't give you that information. I can only verify the claim information you're inquired about today.
[CUSTOMER][NEUTRAL] It shows that no information, right?
[AGENT][NEUTRAL] I cannot give you that information.
[CUSTOMER][NEUTRAL] OK, OK, let me please let me on hold.
[CUSTOMER][NEUTRAL] OK. Uh,
[CUSTOMER][NEUTRAL] OK. Remaining uh balance is can I bill to the patient?
[AGENT][NEUTRAL] I cannot give patient responsibility. I can only verify how the claim was processed.
[CUSTOMER][NEUTRAL] This claim was processed, OK, but the remaining amount, uh is it possible to bill the patient?
[AGENT][NEUTRAL] I cannot tell you to bill the patient or give patient responsibility. I can only verify how the claim was processed.
[CUSTOMER][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, uh, what was the call reference number?
[AGENT][NEUTRAL] We don't give reference numbers, you may use my name in today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you for giving this information, [PII].
[AGENT][POSITIVE] Mhm. You're welcome.
[CUSTOMER][NEUTRAL] For your patience and
[AGENT][POSITIVE] Thanks for calling APL bye.
[CUSTOMER][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.