AccountId: 011433970860
ContactId: ea2e4d84-c52b-438f-a645-dc3a4bd42df9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 410059 ms
Total Talk Time (AGENT): 107082 ms
Total Talk Time (CUSTOMER): 147195 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/ea2e4d84-c52b-438f-a645-dc3a4bd42df9_20250509T21:03_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm [PII] calling from Northland Radiology. I'm here to check on the claim status. How are you doing today?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][POSITIVE] Yeah, so far so good. Thanks for asking.
[AGENT][NEUTRAL] Can I get your uh callback number, [PII]?
[CUSTOMER][NEUTRAL] Yeah, sure. So the callback number is [PII].
[CUSTOMER][NEUTRAL] [PII]. And the extension is [PII].
[AGENT][NEUTRAL] And do you have the policy number of that patient?
[CUSTOMER][NEUTRAL] Yeah, I do so.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The policy number would be 02089012.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Yup. The patient's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] And date of service and bill charges?
[CUSTOMER][NEUTRAL] Yeah, the date of service is on [PII] and the total charge amount is $678 even.
[AGENT][NEUTRAL] OK, um, can you hold on one moment?
[CUSTOMER][POSITIVE] Sure. Take your time.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Come get these dogs.
[AGENT][NEUTRAL] But babe, my door's not open. Will you open it?
[AGENT][NEUTRAL] Please
[AGENT][NEUTRAL] I was waiting for you before I took my break, so.
[AGENT][POSITIVE] Yes bud, how are you doing?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, thanks for holding. Uh, and you said what was the date of service [PII], is that right?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] OK, and what is the bill charges? Sorry about that.
[CUSTOMER][NEUTRAL] Uh, that's fine, no problem. So the bill charge amount is $678 even.
[AGENT][POSITIVE] OK, looks like we received that on, I'm sorry.
[AGENT][NEUTRAL] Uh, that was received on [PII], process [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, outpatient benefit maximum for the calendar year was met, dollar amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, you said that the outpatient maximum dollar amount was met by the patient?
[AGENT][POSITIVE] Yes, for the policy, yes.
[CUSTOMER][NEUTRAL] Uh, all right, then.
[CUSTOMER][NEUTRAL] Then of course the bill charges should be covered by the insurance, right? If the out of pocket maximum was met?
[AGENT][NEUTRAL] So this is a secondary policy, so they have a certain dollar amount that we'll pay per calendar year and it was already met by the time you submitted the claim.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] So the charge amount would be the patient's responsible, right?
[AGENT][NEUTRAL] Uh, no, we can't instruct you on patient responsibility because it's a secondary policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But uh APL is not responsible for these charges since they have already paid the max amount for the outpatient services, right?
[AGENT][POSITIVE] Correct, we won't pay anything because the max has been met. That's correct.
[CUSTOMER][NEGATIVE] We won't pay anything because.
[CUSTOMER][NEUTRAL] Uh, but ma'am, uh, I could see here that the place of service here is 23, which is an emergency service. So, could you please, uh, double check this if we could take the claim back for reprocessing.
[AGENT][POSITIVE] The maximum's been met, and let me give you that maximum.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's just it's a blanket maximum for emergency outpatient, any kind of outpatient services, so.
[CUSTOMER][NEUTRAL] All right. OK.
[AGENT][NEUTRAL] There's not a specific emergency benefit.
[CUSTOMER][POSITIVE] OK. Thank you so much for that information. And uh
[CUSTOMER][NEUTRAL] Can I have your name spelled out for my documentation purpose, please?
[AGENT][NEUTRAL] Yes, it's [PII]. It's [PII]
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK. Thank you. Thank you, [PII]. But [PII], uh, if I could get the maximum dollar amount and when that was met, it would be a great help for me.
[AGENT][NEUTRAL] The maximum dollar amount is $2000.
[AGENT][NEUTRAL] And that was met um in February.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] In February. Thank you.
[CUSTOMER][POSITIVE] Thank you so much for that information, [PII]. And yes, can I have the reference number to our call, please?
[AGENT][NEUTRAL] Uh, reference number is my name and today's date.
[CUSTOMER][POSITIVE] Thank you so much for that. And uh since we have not received any explanation of benefits from you, could you please fax the UOB to my fax number if possible?
[AGENT][NEUTRAL] Yes, what's your fax number?
[CUSTOMER][NEUTRAL] Yeah, great. So just give me a second. So my fax number would be 650396.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 3049
[CUSTOMER][NEUTRAL] Attention would be the number which is 1295919.
[AGENT][NEUTRAL] OK, I'll get that faxed over. Just give me a few minutes.
[CUSTOMER][POSITIVE] Sure, thank you so much for that help, uh, [PII].
[AGENT][POSITIVE] OK, thank you for calling APL. I hope you have a good weekend.
[CUSTOMER][NEUTRAL] Yeah, you as well. Bye-bye.
[AGENT][NEUTRAL] Bye bye.