AccountId: 011433970860
ContactId: caabde7b-b3ef-4af2-9a75-992cabef165d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 400989 ms
Total Talk Time (AGENT): 174002 ms
Total Talk Time (CUSTOMER): 75864 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/caabde7b-b3ef-4af2-9a75-992cabef165d_20250108T19:29_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII] speaking. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] with the University of Iowa. I got 3 claims here I need status on.
[AGENT][NEUTRAL] Sure, I can help you with the claims that [PII], can I please have a callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and then they're all for the same patient or different patient?
[CUSTOMER][POSITIVE] Yep, I'll stay patient.
[AGENT][NEUTRAL] OK, and may I please get the policy certificate or member ID?
[CUSTOMER][NEUTRAL] ID is 01849095.
[AGENT][POSITIVE] Thank you [PII], just one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can I please have you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yep, it's [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And we can go ahead and start with that first.
[AGENT][NEUTRAL] Data service and the amount please.
[CUSTOMER][NEUTRAL] First one is for data service of.
[CUSTOMER][NEUTRAL] 822 2024 for $183.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Next one is for 85-2024 for 145.
[CUSTOMER][NEUTRAL] And then the last one is 8-12-2024 for 717.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And just give me one moment to search the claims please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, just give me a moment to pull a claim image, uh.
[AGENT][NEUTRAL] If I have 2485, I'm just gonna pull that image up real quick.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, it looks like one was paid.
[CUSTOMER][NEUTRAL] So that one looks like they had 2.
[CUSTOMER][NEUTRAL] What is this? I don't know what that CP2 code is. They had two of them that day just to let you know.
[AGENT][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] If that helps you any.
[AGENT][NEUTRAL] OK, for that 8
[CUSTOMER][NEUTRAL] When's the reading and what's the.
[AGENT][NEUTRAL] Yeah, for the.
[AGENT][NEUTRAL] 4518 OK for the 8 1220 24 for 717?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim number is 3514.
[AGENT][NEUTRAL] 518.
[AGENT][NEUTRAL] Receive date is [PII].
[AGENT][NEUTRAL] Processed on [PII].
[AGENT][NEUTRAL] And that claim denied due to the uh calendar year maximum is met.
[CUSTOMER][NEUTRAL] OK, we never got that EOB.
[AGENT][NEUTRAL] OK, I can send it to you if you'd like.
[CUSTOMER][POSITIVE] Yeah that'd be wonderful.
[AGENT][NEUTRAL] OK, and 85 2024 for 145?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim and these look like they were all received and processed the same date received date [PII] process [PII] that claim number 3514535.
[AGENT][NEUTRAL] And that claim denied uh maximum uh met for the calendar year.
[CUSTOMER][POSITIVE] OK, that one we need that you will be too.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then for the.
[AGENT][NEUTRAL] 822 data service.
[AGENT][NEUTRAL] Again, that same receive date [PII] process 10-7.
[AGENT][NEUTRAL] Uh wait, that was 183 for 822. Yeah, claim number 3,514,520 and that same denial was the maximum calendar year, uh, maximum benefit met for the calendar year now what um.
[CUSTOMER][NEUTRAL] I forgot to ask these all patient responsibility then.
[AGENT][NEUTRAL] Well, we don't determine the patient responsibility. This policy is a limited, uh, medical supplemental benefit plan, so it's like a gap plan.
[AGENT][NEUTRAL] So they have um they have that maximum uh benefit that's allowed, um, and once that uh is met, uh, we, we don't, again, we don't determine the patient responsibility. There is no network with this plan. So once their benefits are exhausted, um, that's our obligation to the claim is, is fulfilled.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what fax number can I send this to you at, [PII]?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And to your attention
[CUSTOMER][POSITIVE] Yeah, that'd be great.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, did you have any other questions, [PII]?
[CUSTOMER][POSITIVE] No, that is it. Thank you very much.
[AGENT][POSITIVE] You're welcome I'll send these over to you momentarily.
[AGENT][NEUTRAL] They'll be received um individually just so you're aware.
[CUSTOMER][POSITIVE] OK thank you have a great day.
[CUSTOMER][POSITIVE] OK, OK, sounds good thank you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're welcome thank you for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye.