AccountId: 011433970860
ContactId: e195aedc-1da4-40e9-ba91-8f74afe905bf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 620150 ms
Total Talk Time (AGENT): 207191 ms
Total Talk Time (CUSTOMER): 313724 ms
Interruptions: 5
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/e195aedc-1da4-40e9-ba91-8f74afe905bf_20250617T18:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from the Memorial Hospital of Carbon County.
[CUSTOMER][NEUTRAL] And I need to check the claim status for one of the patients.
[AGENT][NEUTRAL] OK, and you said your name is [PII]?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes, [PII]
[AGENT][NEUTRAL] And may I please have a callback number?
[CUSTOMER][NEUTRAL] Sure, the callback number is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] Sure, the policy number, just give me a moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Just stay on the line.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, the policy number is 02567762.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII].
[CUSTOMER][POSITIVE] Yes yes.
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] And may I have the date of service and total bill?
[CUSTOMER][NEUTRAL] Sure, the date of service is [PII]. And there's a two claims. One is, one is for $319 and another one is for $1,018.
[CUSTOMER][NEUTRAL] Oh
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's 11:29 to 24 for total bill 319 and 1018. I'm pulling that information up for you now.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Well that's right.
[AGENT][NEUTRAL] And for the data service, well, for the total bill of 319, it is showing that we did receive that claim.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that claim number is 354.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 3000.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That claim was received on on December.
[CUSTOMER][NEUTRAL] Mm just give ma'am. Yeah, just give me.
[AGENT][NEUTRAL] OK, [PII], I can't continue to stay on hold. I need to give you this information so I can continue with other calls.
[CUSTOMER][NEUTRAL] yeah.
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, yeah, spell, uh, can you please spell, uh, uh, repeat again? Sorry.
[AGENT][NEUTRAL] OK, and this will be my last time repeating. We did receive the claim on [PII].
[CUSTOMER][NEUTRAL] What is the claim number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That claim number is 354.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 30
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 00. It processed and made a payment in the amount of $50.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Once that $50 was paid, that was the per calendar day max that could have been paid out for that date of service.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] I'm sorry, what is the paid amount?
[AGENT][NEUTRAL] $50.
[CUSTOMER][NEUTRAL] $50 paid amount. And what is, what is the total allowed amount?
[AGENT][NEUTRAL] $50 was the maximum amount that could be paid out.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And yeah.
[CUSTOMER][NEUTRAL] Sure. And uh what is the payment method, method like it is been paid by check or do you have to?
[AGENT][NEUTRAL] It's by check. Are you ready for that check number?
[CUSTOMER][NEUTRAL] Yes, please forward me the check number.
[AGENT][NEUTRAL] The check number is 202.
[CUSTOMER][NEUTRAL] Yes, and some.
[AGENT][NEUTRAL] 01
[AGENT][NEUTRAL] 87
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] 87 and what is the payment date?
[AGENT][NEUTRAL] That will be the processing date, which is [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] [PII]:27.
[CUSTOMER][NEUTRAL] 27 [PII] 24. And I want to ask, uh, it is paid in the bulk amount or a single payment.
[AGENT][NEUTRAL] That is single
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] And there's one more question. Uh, is this check has been cashed out or not?
[AGENT][NEUTRAL] Let me check to see if I can verify that for you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Mhm. Sure. Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It does show that the check is cleared and the cleared date is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII] and I just want to confirm that address it is send with the corrected address which is yeah it which is
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] It did go to [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, and it has cleared, so they did.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Clear that check, they did.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. And what about the another claim which is for $1,018?
[AGENT][NEUTRAL] For the
[AGENT][NEUTRAL] For the one that's $1,018 it does show that we did receive that claim as well.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the receipt date for that claim.
[AGENT][NEUTRAL] Is [PII].
[AGENT][NEUTRAL] That one was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That claim is showing that the maximum amount had been paid out, so it denied we had no other available balance for that member.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Maximum around the amount has been paid out.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And can you please confirm when was the last time that amount has been paid out?
[CUSTOMER][NEUTRAL] For this
[AGENT][NEUTRAL] That would be on the claim that I just indicated for you.
[CUSTOMER][NEUTRAL] Like what is the last time?
[CUSTOMER][NEUTRAL] OK, so after that, uh, the benefit has been exhausted, like, right, like maximum allow amount has been as mhm.
[AGENT][NEUTRAL] Yes, I, I stated on the previous claim the maximum amount was paid out for that date of service. So with this being the same date of service, there's no benefits available for that date of service.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, OK, so for this uh claim, uh, patients once like for this month, right?
[AGENT][NEUTRAL] That is the provider's discretion.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, so we have to adju the claim, OK.
[CUSTOMER][NEUTRAL] OK, yeah, and one more thing, can you please uh fax the uh explanation of benefit you will pay.
[AGENT][NEUTRAL] May I have the fax number, please?
[CUSTOMER][NEUTRAL] Sure. The fax number is [PII].
[AGENT][NEUTRAL] And is that for both of them or just the one that did not mam?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No, no, please fax, uh, both, uh both you be.
[AGENT][NEUTRAL] OK, and the attention.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, attention. Yeah, you can mention uh explanation benefits.
[AGENT][NEUTRAL] OK. Attention who? Who am I putting to the attention these EOBs?
[CUSTOMER][NEUTRAL] Uh, memorial Hospital of Carbon County just facility in.
[AGENT][NEUTRAL] Just put the facility name for the attention to.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm, no, that's all. Can you please spell out your name and give me the reference number?
[AGENT][NEUTRAL] Yes, the reference number will be my first name [PII], which is spelled [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] and today's date will be used as the call reference.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, [PII]. Thank you so much for the information.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life. [PII] have a great day.