AccountId: 011433970860
ContactId: cd0d98bd-cfa4-416d-bb36-cf9602067012
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1011469 ms
Total Talk Time (AGENT): 394177 ms
Total Talk Time (CUSTOMER): 335343 ms
Interruptions: 3
Overall Sentiment: AGENT=0.8, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/cd0d98bd-cfa4-416d-bb36-cf9602067012_20250130T20:08_UTC.wav
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[AGENT][POSITIVE] Good afternoon thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] calling from provider's office. I want to check the claim status.
[CUSTOMER][NEUTRAL] um.
[AGENT][NEUTRAL] Alright, I can help you with that. You said your name is [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you [PII] and what is the callback number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, sure. My callback number is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] 02250224.
[AGENT][NEUTRAL] And the patient's name and date of birth, please, sir?
[CUSTOMER][NEUTRAL] Yeah, sure. It's uh mm [PII], and the date of birth is [PII].
[AGENT][POSITIVE] All right, thank you. And it would be my pleasure to assist you with that claim status, [PII]. Do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] 7.
[CUSTOMER][NEUTRAL] Yeah, the date of service is on
[CUSTOMER][NEUTRAL] [PII] and the total charge amount is $2,862 even.
[AGENT][POSITIVE] OK, thank you. I'm checking on that for you. Bear with me.
[AGENT][NEUTRAL] And the name of the facility, please?
[CUSTOMER][NEUTRAL] Yeah, sure. The facility name is
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] It's Galloway Anesthesia Associate Galloway Anesthesia.
[CUSTOMER][NEUTRAL] Sorry, it's Gastro Health LLC.
[AGENT][POSITIVE] OK. All right. Thank you.
[CUSTOMER][NEUTRAL] Sorry, sorry. Mhm.
[AGENT][POSITIVE] That's not a problem. I was, I was fixing to try to pull that up cause I had the gastrohealth.
[AGENT][NEUTRAL] But I can help you with that claim information, [PII]. We did receive that claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] And this is 24. The claim was denied as the
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Maximum amount payable for this occurrence has been met.
[CUSTOMER][NEGATIVE] So the maximum benefits has been exhausted.
[AGENT][POSITIVE] That's correct for that, for that occurrence.
[CUSTOMER][NEUTRAL] So it has been exhausted in dollar amount or in visits?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] It's going to be $1 amount and per occurrence we can pay up to $500 per occurrence.
[CUSTOMER][NEUTRAL] uh.
[CUSTOMER][NEUTRAL] To $500 in a year in a calendar year, once in a calendar year, right?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] No, sir, it's
[AGENT][NEUTRAL] No, sir, it's per occurrence, and the definition of occurrence is every 90 days for the same or related condition.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it's per occurrence.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] For every 90 days?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] For every 90 days.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] For the same or related condition.
[CUSTOMER][NEUTRAL] Mm, and next, I will.
[CUSTOMER][NEUTRAL] For the same.
[AGENT][NEUTRAL] Mhm. Same or same or related condition.
[CUSTOMER][NEUTRAL] Condition
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. OK. So may I know that when it has been used the last?
[AGENT][NEUTRAL] Uh, that benefit amount was met.
[CUSTOMER][NEUTRAL] Date of service.
[AGENT][NEUTRAL] For this occurrence.
[AGENT][NEUTRAL] For data er it's the same data service we just paid the maximum benefit.
[AGENT][NEUTRAL] To a different provider because they sent in the claim prior to yours.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so may I know the providers the discount?
[AGENT][NEUTRAL] Uh, we don't apply any discounts. We are secondary to their major medical.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I scare, yeah, sorry.
[AGENT][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] OK. And uh can you give me the claim number?
[AGENT][NEUTRAL] The claim number is 349.
[AGENT][NEUTRAL] 3714.
[CUSTOMER][NEUTRAL] And can you please uh fax I will be I will provide my fax number.
[AGENT][NEUTRAL] EOBs are obtainable from our provider portal that is at secured and it's SEC.
[AGENT][NEUTRAL] You are E D as in Delta. It's a simple self-registration using the tax ID number and the patient's account number listed in box 26 on the HIFA.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. And next we move to the next question.
[AGENT][POSITIVE] If you have more, just one moment, I'll be happy to assist you with another patient.
[AGENT][NEUTRAL] [PII], I am ready for that next policy number.
[CUSTOMER][NEUTRAL] 02473158 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] Thank you, [PII]. And what is that patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Yeah, the patient's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Alright thank you and what is that date of service for [PII]?
[CUSTOMER][NEUTRAL] [PII]. Mhm. It's on [PII].
[AGENT][POSITIVE] Oh, I'm sorry.
[AGENT][NEUTRAL] It's [PII]. Hang on.
[CUSTOMER][NEUTRAL] [PII] and the total charge amount is $3,0045 even.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] Is it going to be for the same provider?
[AGENT][NEUTRAL] Gastrohealth or is this a different one?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Um, it's uh Galloway Anastasia Associates.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] That claim we received on [PII].
[AGENT][NEUTRAL] Processed on [PII].
[AGENT][NEUTRAL] And this claim was denied as the maximum benefit.
[AGENT][NEUTRAL] For this date of service has been met.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] So it has been made through.
[CUSTOMER][NEUTRAL] In dollar amount or in visits?
[AGENT][NEUTRAL] Dollar amount and that dollar amount is $300 per calendar day.
[CUSTOMER][NEUTRAL] $300 per calendar in a calendar year.
[AGENT][NEUTRAL] Per calendar day.
[CUSTOMER][NEUTRAL] For calendar day?
[AGENT][NEUTRAL] Is it per, yes, sir, per day.
[CUSTOMER][NEUTRAL] Per day.
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] Would you like this claim number?
[CUSTOMER][NEUTRAL] So it is not for every day for the same or related conditions, right?
[AGENT][NEUTRAL] Now this is this policy pays different than the other one. This is a per calendar day benefit.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So per day,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Their benefit amount for the covered services is $300.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And that is the maximum that we can pay.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Toward the cover services.
[CUSTOMER][NEUTRAL] OK. Mhm. And uh the date of service.
[AGENT][NEUTRAL] Per day
[CUSTOMER][NEUTRAL] And uh may I know the uh when it has been used for the last date of service? It is on the same on uh [PII]?
[AGENT][NEUTRAL] Same day.
[AGENT][POSITIVE] Yes, sir, that's correct.
[CUSTOMER][NEUTRAL] Same day, right? But the diff different provider?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, sir?
[CUSTOMER][NEUTRAL] And can you give me the claim number?
[AGENT][NEUTRAL] The claim number is 353.
[AGENT][NEUTRAL] 7893.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And next, we'll move to the next question.
[AGENT][NEUTRAL] Yes sir how many claims do you have?
[CUSTOMER][NEUTRAL] I have lost 2 patients, 2 more patients.
[AGENT][NEUTRAL] All right, not a problem. What's that next policy number?
[CUSTOMER][NEUTRAL] It's 01896036. M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] And that name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure. It's uh [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you and what is that data service please sir?
[CUSTOMER][NEUTRAL] Um, [PII], 2024 and the total charge amount is $2610 even.
[AGENT][NEUTRAL] 85 2024
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] You said $2610?
[CUSTOMER][NEUTRAL] Yes, 2610.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is that provider name?
[CUSTOMER][NEUTRAL] Um, one moment.
[CUSTOMER][NEUTRAL] It's Galloway Anesthesia Associates.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I'm checking on that claim for you, bear with me.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] This claim
[AGENT][NEUTRAL] [PII], we've received this claim on [PII].
[AGENT][NEUTRAL] Processed on [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Ready.
[AGENT][NEGATIVE] And this claim also was denied as the max benefits met.
[CUSTOMER][NEUTRAL] In a dollar amount?
[AGENT][NEUTRAL] Dollar amount $500 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For calendar year?
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] You're ready for the claim number?
[CUSTOMER][NEUTRAL] And it has been it has been used for the last date of service?
[AGENT][NEUTRAL] That was maxed out for data service 85.
[AGENT][NEUTRAL] Same data service.
[CUSTOMER][NEUTRAL] Same data of, same data service. And can you give me the claim number?
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] That your claim number is 3506454.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And next we move to the last question.
[AGENT][NEUTRAL] All right. I am ready for that policy number.
[CUSTOMER][NEUTRAL] Uh, it's 01989414 M as in Mike, L as in Lima, number 7.
[AGENT][NEUTRAL] And that name and date of birth?
[CUSTOMER][NEUTRAL] Uh, sure. The name is
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you and that data service.
[CUSTOMER][NEUTRAL] [PII] and the total charge amount is 1362.
[AGENT][NEUTRAL] Alright, so bear with me just one moment because this policy turned on [PII]. I'm checking to see if [PII] had active coverage for your data service. Bear with me just one moment.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII], he does have an active policy for that data service and his policy is current. Can I give you the correct policy number?
[CUSTOMER][NEUTRAL] Mhm. So the policy is term?
[AGENT][NEUTRAL] The policy number that you gave me, the 1989414, turned on [PII].
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] It has been billed for the uh member ID for the data service.
[AGENT][NEUTRAL] For that date of service, and he does have an active policy for that date. I can give you the correct policy number.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The correct policy number for [PII] is 246.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 2857.
[CUSTOMER][NEUTRAL] This time.
[AGENT][NEUTRAL] That's the correct policy number.
[CUSTOMER][NEUTRAL] So, mhm. So for this uh policy, so can you give me the effective date?
[AGENT][NEUTRAL] Sure, the effective date is [PII].
[AGENT][NEUTRAL] And what is the facility name on this claim?
[CUSTOMER][NEUTRAL] It's Gastro Health LLC.
[AGENT][NEUTRAL] Thank you [PII]. We did place that on the correct policy, so it does not need to be resubmitted under the correct policy number we did it for you and this claim.
[AGENT][NEUTRAL] We received on [PII].
[AGENT][NEUTRAL] It was processed on [PII]?
[AGENT][NEUTRAL] And denied is the maximum benefit for that data service has been met.
[CUSTOMER][NEUTRAL] In or in visits?
[AGENT][NEUTRAL] Dollar amount, that dollar amount per calendar day is $1000.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Per day?
[AGENT][NEUTRAL] Per day.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And that was maxed out on the same data service.
[AGENT][NEUTRAL] 7:16.
[CUSTOMER][NEUTRAL] And that yeah yeah.
[CUSTOMER][NEUTRAL] And can you give me the claim number?
[AGENT][NEUTRAL] That claim number is 352.
[AGENT][NEUTRAL] 2236.
[CUSTOMER][NEUTRAL] And can you spell your name?
[AGENT][NEUTRAL] My name is [PII]
[AGENT][NEUTRAL] First initial last name [PII].
[CUSTOMER][POSITIVE] Mhm. Yeah. OK. Thank you. Thank you so much. Have a good day. Bye-bye.
[AGENT][POSITIVE] It's been a pleasure to help you with that claim status today, [PII]. Thank you for calling APL and I hope you have a wonderful afternoon.
[CUSTOMER][NEUTRAL] Yeah