AccountId: 011433970860
ContactId: eac22d09-abdf-441d-816a-dd9abbb6e058
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 515739 ms
Total Talk Time (AGENT): 170381 ms
Total Talk Time (CUSTOMER): 208698 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/eac22d09-abdf-441d-816a-dd9abbb6e058_20250107T18:04_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling on behalf of provider office checking on our claim status.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status, Mr. [PII]. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Uh-huh. Callback number of [PII].
[CUSTOMER][NEUTRAL] [PII] with extension [PII].
[AGENT][NEUTRAL] Yes, [PII] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yes, so.
[AGENT][NEUTRAL] All right. And may I have the patient's policy number?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh let me grab that. It is uh 018.
[CUSTOMER][NEUTRAL] 462-60
[CUSTOMER][NEUTRAL] M as in Mike, L as in Larry, number 8.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, and what's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Uh, this is for [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Thank you. And uh we are looking for a date of service of uh [PII].
[CUSTOMER][NEUTRAL] And the charge amount I have is for $15,382 even.
[AGENT][NEUTRAL] OK. That's [PII] $15,382 even, is that correct?
[CUSTOMER][NEUTRAL] Mhm. Yes.
[AGENT][NEUTRAL] OK. All right. And for mhm.
[CUSTOMER][NEUTRAL] And uh
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh, sorry to cut you off and uh on this claim, I do have a specific, uh, query on this.
[AGENT][NEUTRAL] OK. Let me pull the image of the EOB.
[CUSTOMER][NEUTRAL] Mhm. And uh
[CUSTOMER][POSITIVE] Yeah, please take your time.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] OK, for future, you can check claim status online through our website at [PII].
[AGENT][NEUTRAL] And let's see, OK, I'm still waiting on the document, OK?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Uh-huh, please take your time.
[AGENT][NEUTRAL] OK, so I have it pulled up and how may I assist you with this claim?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mhm. Yes, sir, thank you. And actually, uh, we have received an EOB copy of the claim, uh, with, uh, we have received a payment of $249.75. Uh, like, uh, on the claim, uh, when I was just on the claim, I do find that there was an in in uh like I mean to say, incomplete your bill was being uh posted in our system where, uh,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The allowed amount from the uh primary payer for the patient responsibility was for $916. And uh but we have received a payment of $249.75. And uh I just wanna know like uh what's the remaining balance on the claim?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so with the payment of the $249.75 the member has exhausted the benefit for the year. So that was the remaining, and that's what we send out the $249.75 so anything else that is remaining.
[AGENT][NEUTRAL] It's up to the provider's discretion. It is on the member's responsibility from the major medical, so, um, you can take action from there, but we did pay the 24975 that was the remaining balance of the outpatient maximum for the year.
[CUSTOMER][NEUTRAL] OK. Uh, so, uh, I just wanna know like, uh, the remaining balance of $666.25. Uh, will it be the patient responsibility?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Based on the primary EOB it is we are just the secondary only thing we can do is give you the denial of the remaining. Other than that, you just follow the primary.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Uh, one moment, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, thank you so for being online and uh I just wanna know like, uh, can we be able to build this uh $666.25 to a patient?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] It's up to the provider's discretion. I cannot really tell you what to do with the remaining of the claim because we don't have any contractual involvement, but it's up to the provider's discretion if that's what the provider wants to do, they can.
[AGENT][NEUTRAL] Hello, Mr. [PII].
[AGENT][NEUTRAL] Hello, yeah, you too, OK.
[CUSTOMER][NEUTRAL] Uh, so, so, uh, sorry to get you off uh, I'll just transfer my call to one of my floor manager to, just to let you know that, uh, the information on the uh claim. Thank you. And, uh, his name is [PII] and uh I'll be transferring the call to him. Thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] What's what's the name?
[CUSTOMER][NEUTRAL] 5
[AGENT][NEUTRAL] Oh, how do you spell that?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] You don't know how to spell it?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] No, [PII].
[AGENT][POSITIVE] 18. OK, thank you.
[CUSTOMER][NEUTRAL] All right. I'll be transferring. Thank you, sir.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] For your available information and assistance. Bye bye for now.
[AGENT][POSITIVE] Have a good day bye bye.
[CUSTOMER][NEUTRAL] Hi, yes sir.
[AGENT][NEUTRAL] Hi, Mr. [PII]. This is So with APL.
[CUSTOMER][NEUTRAL] Yeah, it's a moment. And I was checking here. The primary was processed towards patient responsibility, $916.
[CUSTOMER][NEUTRAL] And it was billed to secondary insurance.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And from your insurance, we have received a payment for $249.75.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] The reason for the payment again, let me go ahead and explain to you just like I explained it to [PII], uh, the reason for the 249 75 is because with the payment of that check, the member has exhausted his benefit for the year.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] OK, the patient has extra benefits. So, for the dollar value or visit value they have extra?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] dollar value.
[CUSTOMER][POSITIVE] Dollar value, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And what is the patient they have dollar for the year?
[AGENT][NEUTRAL] OK, let me go ahead and get that for you. And this is not a guarantee of payment, just a verification of coverage. And it looks like this one has a $500 daily value.
[CUSTOMER][POSITIVE] Sure, thank you so much.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, sir. Thank you so much.
[AGENT][NEUTRAL] You're welcome. Is there anything else I may help you with today, Mr. [PII]?
[CUSTOMER][POSITIVE] No, that's it. Thank you so much. And could you please provide me the call reference number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's date.
[CUSTOMER][POSITIVE] OK, sure. Thank you so much.
[AGENT][POSITIVE] You're welcome and thank you for calling ATM. Have a good afternoon. Bye bye.
[CUSTOMER][NEUTRAL] Yeah, bye-bye.