AccountId: 011433970860
ContactId: e0c214c6-964f-4aef-ba51-6f54712dfad8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 363859 ms
Total Talk Time (AGENT): 161558 ms
Total Talk Time (CUSTOMER): 77920 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/e0c214c6-964f-4aef-ba51-6f54712dfad8_20250520T15:12_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] with Surgery Center Adventure. I'm calling for claim status.
[AGENT][NEUTRAL] OK [PII], you're needing claim status for a member, is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, I can help you with that. [PII], what is your callback number?
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] Thank you. And what is the member's policy number, please?
[CUSTOMER][NEUTRAL] It's 02506900 ML 8.
[AGENT][POSITIVE] OK, thank you. Give me a couple of moments please to get the member's information pulled up.
[AGENT][NEUTRAL] [PII], any information that I do provide will be a verification and benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh, [PII] $300.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do see that this claim was received. It was received on [PII]. It was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 360-1187.
[AGENT][NEUTRAL] There has been a benefit paid in the amount of $300.
[AGENT][NEUTRAL] On single check 204.
[AGENT][NEUTRAL] 4401.
[CUSTOMER][NEUTRAL] Perfect. OK, can we look at a second data service of [PII]?
[AGENT][NEUTRAL] For the same member?
[CUSTOMER][NEUTRAL] Same number, yes.
[AGENT][NEUTRAL] And the total bill amount for the [PII] data service?
[CUSTOMER][NEUTRAL] 23,649.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, so the most recently received we've received that more than once. The most recently received claim was denied as a duplicate. Let me look at those.
[AGENT][NEUTRAL] Give me just a moment.
[AGENT][NEUTRAL] OK, so the original claim that was received on here.
[AGENT][NEUTRAL] That claim was received on [PII], processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3601195.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] That claim was denied.
[AGENT][NEUTRAL] And the reason for the denial states the maximum.
[AGENT][POSITIVE] Benefi payable for this state of service has been met.
[CUSTOMER][NEUTRAL] And are you OK, can you help me with what that means? Are you suggesting that the, the amount that the primary paid?
[AGENT][NEUTRAL] No, sir, on the supplemental policy.
[AGENT][NEUTRAL] The maximum benefit for this data service, the benefits for outpatient or a per calendar day benefit.
[AGENT][NEUTRAL] And it was met on another claim received prior to your claim being received.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK. Can you fax that explanation of then, so, is, is the patient responsible for the for that balance? So I think it was applied to their deductible from their primary.
[AGENT][NEUTRAL] We
[AGENT][NEUTRAL] Uh, we do not APL does not determine patient responsibility more than that would be up to the provider.
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] Now we do have a portal, [PII], in which now that you have the claim numbers you can actually print the explanation of benefits from our portal.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the website for that portal is located at secured.
[CUSTOMER][POSITIVE] All right, perfect. And
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright perfect thank you and what was your name again?
[AGENT][NEUTRAL] Again, my name is [PII] and you would use my name along with today's date, [PII] if you need a call reference number.
[CUSTOMER][POSITIVE] Thank you so much have a great day.
[AGENT][POSITIVE] Well, you're very welcome. So if that is all I can help you with, and thank you for calling APL and I hope you have a nice day also.
[CUSTOMER][NEUTRAL] All right, bye-bye.
[AGENT][NEUTRAL] Bye bye.