AccountId: 011433970860
ContactId: daaa82ee-1cf3-4f15-829b-a866886dd4b4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 785909 ms
Total Talk Time (AGENT): 208720 ms
Total Talk Time (CUSTOMER): 137928 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/daaa82ee-1cf3-4f15-829b-a866886dd4b4_20250311T18:41_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is So. How may I assist you?
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello, hello, it's [PII] calling on behalf of the provider's office. I just want to know what the claim status for today.
[AGENT][POSITIVE] Oh sure, I can assist you with claims and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Oh yeah, sure. It's [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] It's 01939838.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] The last name is [PII] and the first name is [PII].
[AGENT][NEUTRAL] What's your date of birth?
[CUSTOMER][NEUTRAL] It's um [PII].
[AGENT][NEUTRAL] Thank you. What's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Uh, the date of service is [PII].
[AGENT][NEUTRAL] with the amount.
[CUSTOMER][NEUTRAL] Hm, sorry?
[AGENT][NEUTRAL] The amount of the claim?
[CUSTOMER][NEUTRAL] It's $220.22 dollars. It's $220.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Give me one moment, let me pull the COV, and for the future you can check claim status online through our website at [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] I'm waiting on the ERB to pull up.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hello
[AGENT][NEUTRAL] Yes, I'm waiting on the URB to pull up.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] We have um processed the claim on [PII].
[AGENT][NEGATIVE] And the claim was denied. The reason for this denial is that the maximum benefits for this confinement has been paid, so it's been exhausted.
[CUSTOMER][NEUTRAL] So the maximum benefits has been extra, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, uh, just a moment. Let's, uh, stay, uh, in the, uh, in which time of like, uh, visiting or dollar value?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] It's gonna be dollar value. Let me go ahead and pull the benefits, and this is not a guarantee of payment, just a verification of coverage. And let's see one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I guess we, uh, for this, we have to bill to the patient, right?
[AGENT][NEUTRAL] It's up to the provider's discretion. We don't have any contractual involvement on the remaining of the claim. Um, this one had an inpatient maximum of 1000.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So is that we can bill to the patient?
[AGENT][NEUTRAL] up to the provider's discretion. We cannot make that decision. That's the decision that the provider will have to make. We don't have any contractual involvement.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We're just a secondary. Mhm.
[CUSTOMER][NEUTRAL] So you guys are the secondary insurance and the maximum benefit has been exhausted, right?
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] Correct. He already used all his benefits. Mhm.
[CUSTOMER][NEUTRAL] So, so is that patient have any other insurance?
[AGENT][NEGATIVE] You should have a major medical.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEGATIVE] You should have a major medical but no other insurance with us.
[CUSTOMER][NEUTRAL] OK, so what is the last coordination of benefit updated date?
[AGENT][NEUTRAL] We don't do coordination, we are the secondary.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] The coordination is through the primary.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And can you please provide me the claim number?
[AGENT][NEUTRAL] Sure, the claim number is 3531362.
[CUSTOMER][NEUTRAL] OK just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And call reference.
[AGENT][NEUTRAL] We don't have reference numbers you can use my name into the state if you will.
[CUSTOMER][NEUTRAL] So what's your good name?
[AGENT][NEUTRAL] My name is [PII] [PII].
[CUSTOMER][POSITIVE] Very interested. Just a moment, OK?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, I do have total count of one more claim after this, so just me pull up the claim, OK?
[AGENT][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] I'm sorry, what did you say?
[CUSTOMER][NEGATIVE] I have to count of 2 more claims.
[AGENT][NEUTRAL] You have 2 more claims that you need to go over.
[CUSTOMER][NEGATIVE] I have to counter.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Bear with me just a second. Let me make a note on this one. I'm gonna put you on a brief hold, OK?
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, what's the next policy number, Mr. [PII]?
[CUSTOMER][NEUTRAL] Uh, the policy number is 0197.
[CUSTOMER][NEUTRAL] 3090.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] So far they just want to know about the claim status.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] The last name is [PII] and the first name is [PII].
[AGENT][NEUTRAL] What's the date of birth?
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] The date of service is uh [PII] with the bill charge amount of $234.
[AGENT][NEUTRAL] No, it's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Let me see if there's another policy.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, it's gonna be a minute. I have to pull up a different policy number. One moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm, and you said it was 234. I don't see the one for 234. Let me pull this one again. um.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] I, I did find a new policy. It's a different policy. One moment.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] That is not it. Yeah, this is not it. So no, we don't have that one on file. Um, do you need the new policy number so you can submit that claim?
[CUSTOMER][NEUTRAL] Yeah, please tell me.
[AGENT][NEUTRAL] OK, that is um policy number 0243.
[AGENT][NEUTRAL] 5030.
[CUSTOMER][NEUTRAL] What is the timely filing?
[AGENT][NEUTRAL] We don't have how many filing limits.
[CUSTOMER][NEGATIVE] Uh, you guys don't have time, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, no problem. Uh, I guess that's all for today. Thank you so much. Take care. Bye-bye.
[AGENT][POSITIVE] And you as well Mr. [PII] and thank you for calling APL. Have a good day.