AccountId: 011433970860
ContactId: e72477bd-3878-4d66-8034-993cef0bd857
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 344220 ms
Total Talk Time (AGENT): 130933 ms
Total Talk Time (CUSTOMER): 113460 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/e72477bd-3878-4d66-8034-993cef0bd857_20250328T14:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling with Franciscan Health. I'm just calling to follow up on a claim, please.
[AGENT][NEUTRAL] OK, Ms. [PII], I can help you with the claim, and can you please give me your callback number just in case our call gets disconnected?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] Thank you. And then can you give me one more time the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Yes, it's Franciscan Health [PII].
[AGENT][POSITIVE] Thank you. I appreciate that. And what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Um, the patient's name, the first name is [PII], last name [PII], um, and the policy number is 02586434.
[AGENT][POSITIVE] Thank you, ma'am.
[AGENT][NEUTRAL] And what is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] It's [PII], um, yes, this is birthday [PII]. No, I'm sorry, I'm lying. I'm sorry, [PII].
[AGENT][NEUTRAL] [PII] or [PII]. OK.
[CUSTOMER][POSITIVE] Yes, sorry about that. OK, thank you.
[AGENT][NEUTRAL] Alright, let me look that up real quick. No, that's OK.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and then can you please give me the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Yeah, it was for [PII] for $4,657.85.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold, Ms. [PII], while I look up this claim, and I'll be right back. Thank you, ma'am.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you so much for holding for me, Ms. [PII]. I have the claim um pulled up for you. The claim number is 357.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Like.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 6999.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim was paid $75.
[AGENT][NEUTRAL] And the check number is 2034624 and with that payment, the benefit maxed for the day.
[CUSTOMER][NEUTRAL] OK, so the plan only pays $75 per day then is that how that works?
[AGENT][POSITIVE] Correct. Yes, ma'am.
[CUSTOMER][NEGATIVE] And then can you tell me when that was processed because we received an EOB um but there was no payment made and it just says something about you're waiting on information from benefits and a card.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] Regarding eligibility.
[AGENT][NEUTRAL] Right. Um.
[AGENT][NEUTRAL] The check was issued on [PII].
[CUSTOMER][NEUTRAL] OK, so that was after this one. OK, perfect. Can you give me the check number and OK.
[AGENT][NEUTRAL] Yes ma'am, what happens with that is once we get the eligibility from benefits in a card they check them every single day to wait on that eligibility and once that eligibility comes through they automatically process the claims so that's why there's the gap in the dates of the check and the EOB.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Got you. I just, uh, the remark on the EOB said to call benefits in a cart with questions, and I called there and the guy had no idea what I was talking about. So, OK, so then let me ask you, is the balance, uh, will the balance remaining balance be patient responsibility?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] We don't give patient responsibility because that is up to the provider to decide if they wanna do that, yes.
[CUSTOMER][NEUTRAL] Up to the provider, OK.
[CUSTOMER][NEUTRAL] OK, but you guys don't use like a network price or anything?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK, perfect. Is there a reference number for our call?
[AGENT][NEUTRAL] Yes ma'am, you can use my name. It's [PII] and today's date.
[CUSTOMER][POSITIVE] All right, thank you so much for your help you have a great weekend.
[AGENT][POSITIVE] You too, Ms. [PII], thank you for calling APL. You take care and I hope you have a fantabulous weekend.
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.