AccountId: 011433970860
ContactId: d528b568-02a4-4e17-be80-b30dd4565e3e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 365079 ms
Total Talk Time (AGENT): 145418 ms
Total Talk Time (CUSTOMER): 147279 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/d528b568-02a4-4e17-be80-b30dd4565e3e_20250311T14:17_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I am calling from the HS business office of VHS Brownsville Hospital to check on the claim status.
[AGENT][NEUTRAL] OK, well, I can verify claim status for you, Ms. [PII], and what is that policy number, please?
[CUSTOMER][NEUTRAL] Um, 001868783.
[AGENT][POSITIVE] OK, thank you so much. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Mhm [PII].
[AGENT][NEUTRAL] I'm sorry, what's that phone number?
[CUSTOMER][NEUTRAL] Um, [PII], no extension.
[AGENT][NEUTRAL] OK. Thank you, ma'am. And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Um, this is for [PII], and then the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you so much. And what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] Uh, for a moment, um.
[CUSTOMER][NEUTRAL] Of service is [PII] until [PII] and then um billed amount is $99,071 even.
[CUSTOMER][NEUTRAL] I'll try to
[AGENT][NEUTRAL] OK, and you said the date of service was [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes, [PII] until [PII].
[AGENT][NEUTRAL] OK, and do you have the balance after primary insurance has processed the claim?
[CUSTOMER][NEUTRAL] No, I don't have.
[AGENT][NEUTRAL] OK. And you're calling from?
[CUSTOMER][NEUTRAL] Um, BHS Brownsville Hospital. Do you have any information.
[AGENT][NEUTRAL] OK, 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. AM as in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I'm showing on this claim, it looks like we paid $2550 and with that payment it max the benefit for the calendar year.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] just
[CUSTOMER][NEUTRAL] I think it's for [PII].
[CUSTOMER][NEUTRAL] OK, for a moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, what service, um, has been maxed out?
[AGENT][NEUTRAL] The outpatient benefits for the year.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Outpatient benefit.
[CUSTOMER][NEUTRAL] the year.
[CUSTOMER][NEUTRAL] And then how much is the maximum benefit limit of that service?
[AGENT][NEUTRAL] For outpatient, um, let's see.
[AGENT][NEUTRAL] Showing the patient has an outpatient benefit of up to $2550 per calendar year.
[CUSTOMER][NEUTRAL] Per calendar.
[CUSTOMER][NEUTRAL] And then um that is the allowed amount, is that correct?
[AGENT][NEUTRAL] That is the max benefit that is payable per calendar year.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Is it billable to patients?
[AGENT][NEUTRAL] We can give patient responsibility. We can only verify how the claim was processed and with that payment it match their benefit for the year.
[CUSTOMER][NEUTRAL] OK, um, can I have your appeal's mailing address?
[AGENT][NEUTRAL] Sure, it's [PII], I'm sorry, [PII].
[CUSTOMER][NEUTRAL] Or something.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And to submit an appeal, you must submit a letter stating the reason for the appeal, and you have up to 180 days from the time the claim was processed to submit an appeal.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, let me repeat if I heard it right. The, uh, POs mailing address is [PII]. Is that correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, do you have the fax number?
[AGENT][NEUTRAL] Uh, fax number [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] and what is the appeals timely filing limit?
[AGENT][NEUTRAL] Uh, you have up to 180 days from the time was, uh, the claim was processed, which was [PII] to submit an appeal.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And as I stated, you must submit a letter stating the reason for the appeal.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, can I have the claim number?
[AGENT][NEUTRAL] Sure. Claim number is 355-0849.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] 0849.
[CUSTOMER][NEUTRAL] OK, um, uh, what is your first name again? I didn't get that.
[AGENT][NEUTRAL] I'm sorry, it's [PII].
[AGENT][NEUTRAL] And Ms. [PII], is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] I think that will be all lastly, can I have the call reference number?
[AGENT][NEUTRAL] Uh, we don't give reference numbers. However, if you like, you may use my name in today's date.
[CUSTOMER][POSITIVE] OK, thank you [PII] for assisting me today. Have a great day bye bye.
[AGENT][POSITIVE] Alright, you too, Ms. [PII]. Thanks for calling APL. Bye.
[CUSTOMER][NEUTRAL] OK.