AccountId: 011433970860
ContactId: eec86a99-5c05-44bf-bc4f-54a68dd24853
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 724000 ms
Total Talk Time (AGENT): 237105 ms
Total Talk Time (CUSTOMER): 260046 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/eec86a99-5c05-44bf-bc4f-54a68dd24853_20250401T19:05_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII]. initial to my last name [PII], looking for claims.
[AGENT][NEUTRAL] OK, I got a claim for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] It's [PII]. You can reach me direct.
[AGENT][NEUTRAL] OK, thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Yes, uh, it's 02123559.
[AGENT][NEUTRAL] OK, and then what was the name and date of birth for the member, please?
[CUSTOMER][NEUTRAL] Yeah, the member's name [PII]. Birthday [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that uh what was the date of service for this claim, please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] That was [PII].
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, and then do you have that bill amount?
[CUSTOMER][NEUTRAL] Yeah, for the total charge here, it's $526.
[CUSTOMER][NEUTRAL] 83 cents uh for this claim we have just submitted a claim along with the uh primary EOB and claim form via fax on this [PII].
[AGENT][NEUTRAL] OK, OK, thank you. One moment please.
[AGENT][NEUTRAL] Actually I'm sorry [PII] uh what was the name of the provider's office this was with?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's Shuangali Associates.
[AGENT][NEUTRAL] OK. I do believe I've found it. Give me just a moment. Um, that amount actually, was that, um, before or after major medical paid?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, before the medication, the overall amount, it has been, uh, submitted. Actually, primary has been paid. The primary BCBS has been paid.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, do you have that remaining balance after they paid?
[CUSTOMER][NEUTRAL] Yeah, the remaining balance 9614.
[AGENT][NEUTRAL] 9614. OK, thank you. One moment, please.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, so I do not have a claim for that amount, [PII]. Um, I only have one claim for that date of service, and that was for, uh, from the Stewart Oncology. uh, that amount was, um, total bill charges we have is 16183, and the benefit amount we received was, um, 66.95.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] For the this data service for [PII], right?
[AGENT][NEUTRAL] [PII], yes, from Stewart Oncology Associates.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, it, it, it's included the patient's responsibility. The patient has been paid $30. The remaining balance as yours.
[AGENT][NEUTRAL] OK, so is this the correct claim?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEGATIVE] OK, and it appears that we've not received.
[CUSTOMER][NEUTRAL] $66.14.
[CUSTOMER][NEUTRAL] Yeah, $66.14 remaining. Uh, you do have received a claim we just submitted.
[AGENT][NEUTRAL] Oh, OK. I have $66 and I have a $66.95.
[CUSTOMER][NEUTRAL] Yes, may I know the status of this?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] When you have received the claim after, when you have received this claim, we have submitted this claim on [PII].
[AGENT][NEUTRAL] OK, so this claim was received, let's see.
[AGENT][NEUTRAL] [PII], so that sounds right.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, give me just a moment, let me take a look.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, for this policy, it states all payable benefits were applied to this policy's deductible of $500.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, the deductible of $66.14 with a co-pay patient responsibility, $30.
[AGENT][NEUTRAL] Right, the, the payment, right, so the payable benefits, uh, [PII] has a $500 deductible with us, so that benefit amount went towards that deductible.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, the member has $500 deductible uh with.
[CUSTOMER][NEUTRAL] American Life in public life, right?
[AGENT][POSITIVE] Correct. And I can send you this EOB if you'd like.
[CUSTOMER][NEUTRAL] Yeah, but it's more to the patient's deductible, right? So the benefit for this dollar amount, $60.14 it's applied towards member's deductible, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Yeah, but member has been paid $30 co-pay amount on the same claim.
[AGENT][NEUTRAL] Yeah, all of the benefits payable went towards the $500 deductible that she has with us.
[CUSTOMER][NEUTRAL] So, yeah, you can fax me a copy of an EOB.
[AGENT][NEUTRAL] Sure. What was that fax number for you?
[CUSTOMER][NEUTRAL] It's [PII]. You can use my name as attention or [PII].
[AGENT][NEUTRAL] OK, I'm gonna read that back to make sure I heard that correctly. That was [PII].
[CUSTOMER][NEUTRAL] Right, [PII], right, yes.
[AGENT][POSITIVE] Got it. OK, I'll go ahead and send that to you. Uh, you should get it here within 10 minutes or so. Was there anything else I could help you with?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I do have to check another few more data services before that, can I have the claim number for this?
[AGENT][NEUTRAL] Yes, that is 3572554.
[AGENT][NEUTRAL] And were these other claims for the same member or go ahead I'm sorry.
[CUSTOMER][NEUTRAL] 32
[CUSTOMER][NEUTRAL] Same number same number diff uh same number, different data service uh before the, the claim number for this data service 3572554, right?
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Pros
[CUSTOMER][NEUTRAL] It is this uh in-network directable, right?
[AGENT][NEUTRAL] Uh, this policy does not have an active network. Um, it just, it goes off of major medical, the whoever, uh, they have as major medical.
[CUSTOMER][NEUTRAL] Yeah, on this in this claim, the $66.14 applied towards members deductible, right.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] He my my
[CUSTOMER][NEUTRAL] One moment, I'm just documenting it, just a second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, have I choose the best deductable member has $500 deductible with the American public life.
[CUSTOMER][POSITIVE] Right, got it. Celebrated the next data service if you're ready.
[AGENT][POSITIVE] Yes, I'm ready when you are.
[CUSTOMER][NEUTRAL] The next is going to be [PII].
[AGENT][NEUTRAL] And this is still for [PII], correct?
[CUSTOMER][NEUTRAL] Yeah, same patient, yes, the different date of service for
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, OK, so I'm not showing that we received a claim for that date of service.
[CUSTOMER][NEUTRAL] Same as we have just submitted this claim on [PII] of this year. You're just not receiving it, right?
[AGENT][NEUTRAL] That's correct. I'm not showing that we have a claim for that date of service for this number.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Right, can I have the claim fax number for submission?
[AGENT][NEUTRAL] Yes, that is 877.
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] Oh, so can I get the.
[CUSTOMER][NEUTRAL] Time frame for submitting claim.
[AGENT][NEGATIVE] Uh, there is no timely filing limit.
[CUSTOMER][NEUTRAL] that.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Shall I provide you the next state of service?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I don't have any claims on file for that date of service either.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Also, we have just submitted [PII]. Is this the claim fax number?
[AGENT][NEUTRAL] No, the fax number is the one that I gave you ending in [PII].
[CUSTOMER][NEUTRAL] I'm there.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Any
[CUSTOMER][NEUTRAL] Right, this is the flying facts, right. All right, the, the final one more data service is going to be [PII].
[AGENT][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] [PII]. I'm sorry, [PII].
[AGENT][NEUTRAL] Oh January, OK.
[AGENT][NEUTRAL] Yeah, I don't have any claims for that date of service.
[CUSTOMER][NEUTRAL] Yeah, in this case, uh, you just mentioned the pay uh patient has deductible, but
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah, the primary uh insurance, BCBS has been processed.
[CUSTOMER][NEUTRAL] As the deductible for this patient and apply the payment amount.
[AGENT][NEUTRAL] Yes, this, this policy also has a deductible that must be met before benefits are paid.
[CUSTOMER][NEUTRAL] Yeah, if the primary career, BCBS has been processed towards deductible uh in the payment amount and we need to submit the balance to you, right?
[AGENT][NEUTRAL] Yeah, this policy is designed to help with co-pay, deductible and co-insurance from major medical. However, this particular policy also has a deductible that needs to be met first.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Can I have your name and can I get the call reference number?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Uh so my name is spelled [PII], last initial is [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] That's it. Thank you.
[AGENT][POSITIVE] Of course, thanks for calling APL. Have a great rest of your day.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 0
[CUSTOMER][NEUTRAL] OK.