AccountId: 011433970860
ContactId: d1540cc7-4e45-4bad-92ee-6f19b15f40a8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 659000 ms
Total Talk Time (AGENT): 250406 ms
Total Talk Time (CUSTOMER): 161458 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/d1540cc7-4e45-4bad-92ee-6f19b15f40a8_20250116T21:28_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][NEGATIVE] So voice is breaking my name is.
[AGENT][NEUTRAL] I'm so sorry. My name is [PII].
[CUSTOMER][NEUTRAL] And last name is?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And may I ask your name?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII] and last name is [PII].
[AGENT][POSITIVE] Thank you, [PII]. And what is a good callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] One
[AGENT][POSITIVE] [PII]. Thank you.
[AGENT][NEUTRAL] And [PII], what is the policy number for the patient?
[CUSTOMER][NEUTRAL] Policy number is
[CUSTOMER][NEUTRAL] 0101802609.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII] and date of birth is [PII].
[AGENT][POSITIVE] All right, thank you. And how can I help you this afternoon, [PII]?
[CUSTOMER][NEUTRAL] Gender plan status?
[AGENT][NEUTRAL] Alright, I can help you with that claim status. What is the date of service?
[CUSTOMER][NEUTRAL] Uh, [PII] will be the amount of $62 even.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the facility name?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Malo Regional Medical Center.
[AGENT][NEUTRAL] All right, if you'll bear with me just one moment.
[CUSTOMER][POSITIVE] Sure, take your time.
[AGENT][NEUTRAL] I apologize. Bear with me just one moment.
[AGENT][NEUTRAL] Sorry about that. My system is lagging.
[AGENT][NEUTRAL] All right, I can help you with that claim status.
[AGENT][POSITIVE] I'm showing that we did receive that claim and I'm getting that received date for you. Bear with me one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That claim was received on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the benefit amount was applied to the $1000 calendar year max.
[AGENT][NEUTRAL] Or I'm sorry, calendar year deductible, not max. I apologize.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] And may I know what is the allowed amount for this claim?
[AGENT][NEUTRAL] And the um benefit amount that the on the CPT 93793.
[AGENT][NEUTRAL] Is $15.76 and the benefit amount on 85,610 is $8.60. Those were both applied to the deductible of $1000 deductible.
[CUSTOMER][NEUTRAL] OK. So the loan amount that it was going to be $24.36 right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK and patient made $316.68.
[AGENT][NEUTRAL] I'm sorry, can you repeat that?
[CUSTOMER][NEUTRAL] Uh, may I know the patient me amount?
[AGENT][NEUTRAL] For that $1000 deductible, let me see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] They met 34, I mean sorry $341.04 of their $1000 deductible.
[AGENT][NEUTRAL] For 2023.
[CUSTOMER][NEUTRAL] $3341.04 OK. Uh, so may I know the, when was the last date?
[AGENT][NEUTRAL] And with this claim.
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] It was met with this claim that.
[AGENT][NEUTRAL] Amount was met with this claim.
[AGENT][NEGATIVE] It wasn't, it wasn't the maximum benefit met. It was applied to the deductible.
[CUSTOMER][NEUTRAL] OK, so may I know the claim number?
[AGENT][NEUTRAL] The claim number is 341.
[AGENT][NEUTRAL] 7486
[CUSTOMER][NEUTRAL] OK. And the call reference is going to be your name and to the state, right?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] And could you have a copy of UB?
[AGENT][NEUTRAL] EOBs are obtainable on our provider portal at [PII].
[AGENT][NEUTRAL] Dot A
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So you can't fax a copy of your OB?
[AGENT][NEUTRAL] I can, but it's quicker to get it from the portal. If you don't have an access, I can help you create an account.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Would you like for me to do that?
[CUSTOMER][NEUTRAL] Um, could you please fax it for this time?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Give me just one moment.
[AGENT][NEUTRAL] And can I put it to your attention, [PII]?
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] I'll give you the attention ID which is X as in X-ray 10.
[AGENT][NEUTRAL] OK. Let me, let me.
[AGENT][NEUTRAL] I'm sorry, [PII], bear with me just one moment while I get that.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um, together
[CUSTOMER][POSITIVE] Yeah, sure. Take your time. No problem. Mm.
[AGENT][NEUTRAL] And then I'll get that attention and fax number, so bear with me just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I need to get it
[AGENT][POSITIVE] To come up and then we'll, I'll be happy to take that information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I didn't mean to interrupt you. I apologize.
[CUSTOMER][NEUTRAL] Yeah, it's OK.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] OK, so what is the attention to?
[CUSTOMER][NEUTRAL] It's going to be accessed the next day, 1014207882.
[AGENT][NEUTRAL] And what is the fax number?
[CUSTOMER][NEUTRAL] Next summer is going to be.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so that fax number is [PII].
[AGENT][NEUTRAL] There's a number missing. 7102.
[CUSTOMER][NEUTRAL] 7102.
[CUSTOMER][NEUTRAL] Three consecutive 7 and 7102.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Is that 4 consecutives? No, 3, OK. No, it's 4 consecutive zeros. [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Yeah, exactly.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Alright, give me just one second.
[AGENT][NEUTRAL] And we're putting that to the attention of the patient account number.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] All right, [PII], that is on the way for you. You should be receiving that shortly.
[CUSTOMER][NEUTRAL] OK. So can we move for the next, the next date of service for the patient?
[AGENT][NEUTRAL] Sure, what's that next date of service?
[CUSTOMER][NEUTRAL] It's going to be [PII] with bill amount of $62 even.
[AGENT][NEUTRAL] Now for that data service [PII].
[AGENT][NEUTRAL] I don't have a claim on file.
[CUSTOMER][NEUTRAL] No, [PII] [PII].
[AGENT][NEUTRAL] I'm sorry. Yeah, that's, I'm sorry. Um, [PII].
[AGENT][NEUTRAL] I don't have a claim on file for that data service.
[CUSTOMER][NEUTRAL] So may I know the effective date of this number?
[AGENT][NEUTRAL] The effective date is [PII] and the policy termed on 10-124.
[CUSTOMER][NEUTRAL] OK, and the pay I to resubmit the claim?
[AGENT][NEUTRAL] Payer ID is 608. You're asking for the payer ID?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The payer ID is 60801.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the time limit.
[AGENT][NEGATIVE] No timely filing. We will need the primary EOB along with that claim.
[CUSTOMER][NEUTRAL] OK. So can we move for the next number?
[AGENT][NEUTRAL] Next member?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, bear with me just one second.
[AGENT][POSITIVE] I'm ready for the next policy number.
[CUSTOMER][NEUTRAL] Hi, I should.
[CUSTOMER][NEUTRAL] Give me a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, so then you with the next claim.
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] I want
[CUSTOMER][NEUTRAL] One second please.