AccountId: 011433970860
ContactId: f33ee360-c4be-4bc8-bcdf-a25ea3062683
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 650260 ms
Total Talk Time (AGENT): 268615 ms
Total Talk Time (CUSTOMER): 212514 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/f33ee360-c4be-4bc8-bcdf-a25ea3062683_20250117T16:26_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, hi, good morning. This is [PII] calling from office.
[AGENT][POSITIVE] And how can I help you today, [PII]?
[CUSTOMER][NEUTRAL] I want to check the claim status for a patient. Can you help me out?
[AGENT][NEUTRAL] Yes, I can help you with claim status and [PII], in case this call is disconnected, may I have your callback number?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure. [PII] consecutive 9.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sorry, what was the last four digits?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] 3 consecutive 9.
[CUSTOMER][NEUTRAL] Can I get your name and spelling?
[AGENT][NEUTRAL] That's [PII]
[AGENT][NEUTRAL] And the last four digits said it was [PII]?
[CUSTOMER][NEUTRAL] No, no. [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] me
[AGENT][NEUTRAL] And, and may I have the patient's policy number, please? P as in Paul.
[CUSTOMER][NEUTRAL] And initial your last name?
[CUSTOMER][NEUTRAL] Thank you. And the patient policy number is 2296956.
[AGENT][NEUTRAL] Thank you, and that was 229-6956.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Thank you. May I have the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Patient name is uh [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And may I have the date of service and the bill amount?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] But the amount is $29,941.15.
[AGENT][NEUTRAL] Thank you. So that's for data service of [PII] for $29,941.15.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, I show we received that initial claim on [PII]. It was processed on [PII]. I show we paid $1500 on that initial claim, and it looks like we received that claim.
[AGENT][NEUTRAL] Again, let me take a look.
[AGENT][NEUTRAL] Yeah, and then we received that claim again on.
[AGENT][NEUTRAL] [PII] and it was processed on [PII] informing that this was the max payable for this data service. Would you like the claim number?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The claim number is 35.
[CUSTOMER][NEUTRAL] now
[AGENT][NEUTRAL] 35794.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And is this claim denied?
[AGENT][NEUTRAL] We pay $1500.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] 1500.
[AGENT][NEUTRAL] On the most recent, yes, on the initial claim we that was the max payable for the data service on that claim. That was the max payable was 1500.
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] If you don't mind, uh, could you please tell me the numbers? It's 50, 1500?
[AGENT][NEUTRAL] The numbers for the claim number?
[CUSTOMER][NEUTRAL] No, no, the paid amount.
[AGENT][NEUTRAL] 1500.
[CUSTOMER][NEUTRAL] Actually quite
[CUSTOMER][NEUTRAL] 1500.
[CUSTOMER][NEUTRAL] OK. And is there any denial in this account?
[AGENT][NEUTRAL] We paid 1500 and then on that claim the max, that was the maximum benefit payable for that data service was met.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Therefore, no additional benefits are payable because that was the max payable met.
[CUSTOMER][NEUTRAL] Uh-huh. And is there any patient responsibility in this claim?
[AGENT][NEUTRAL] Looks like based off the EOB that we received, their out of pocket responsibility was $4650.54.
[AGENT][NEUTRAL] And under our coverage were secondary, their outpatient only covers a max of 1500 per calendar day and on this claim they've met their maximum benefit for that data service payable.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] May I know the mode of payment? Is it EFT or check?
[AGENT][NEUTRAL] It's a single check.
[CUSTOMER][NEUTRAL] OK, just a second.
[CUSTOMER][NEUTRAL] Can I get the check number?
[AGENT][NEUTRAL] Yes, that check number is 2004951.
[CUSTOMER][NEUTRAL] It is 2 consecutive 0 or 3 consecutive 0s after 2.
[AGENT][NEUTRAL] 200.
[CUSTOMER][NEUTRAL] OK. And it was a single check?
[CUSTOMER][NEUTRAL] And it's issued on?
[AGENT][NEUTRAL] This claim was processed on [PII].
[CUSTOMER][NEUTRAL] No, no, the check issue date.
[AGENT][NEUTRAL] The [PII].
[CUSTOMER][NEUTRAL] [PII]. OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And cash down.
[AGENT][POSITIVE] Looks like it's currently outstanding still.
[CUSTOMER][POSITIVE] Still outstanding?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So may I know the reason for your?
[AGENT][NEUTRAL] Uh, we, I do
[AGENT][NEUTRAL] It looks like it was issued out to the mailing address that was provided, which is the [PII] is where the check was issued to.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. So actually, there is an incorrect address. So can you, once again, uh,
[AGENT][NEUTRAL] That's the address that's listed on the UB that we received.
[AGENT][NEUTRAL] It's Hileaa [PII] is what's listed on the claim that was filed with us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, but still, it's not yet cash. So can you once again raise the check?
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] That's the same address that was also listed on the 2nd claim that we received the duplicate claim as well.
[AGENT][NEUTRAL] The claims billing address, that's what's the same address listed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, how, when will we get the um check uh like how many days that it would take?
[AGENT][NEGATIVE] That was submitted last year in September, so you should have already received it.
[CUSTOMER][NEUTRAL] OK, so once I, once again I'm raising the check traer, right? So I know how many days that I need to uh
[AGENT][NEUTRAL] What is the correct, what address?
[AGENT][NEUTRAL] What address should it have been mailed to outside of what was listed on the UB that was provided to us?
[CUSTOMER][NEUTRAL] Yeah, it's already on your file that you just brought me right now. [PII]. That is the address. So just
[AGENT][NEUTRAL] So that is the correct address?
[CUSTOMER][NEUTRAL] Yeah, ma'am. As for checking, I just found out. So that's why I'm just uh uh asking to raise the check raise for this one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, we'll send a request.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, thank you so much. So, uh, can I allow 10 to 20 days?
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] There is no denial in this claim, right?
[AGENT][NEUTRAL] We pay the claims. We paid the claim, so the max was payable for this data service.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. And can I request a copy of
[AGENT][NEGATIVE] It was a denial on the the duplicate claim that was submitted to us because they've already met their max for this state of service.
[CUSTOMER][NEUTRAL] Sure. Can I request a copy of POB?
[AGENT][NEUTRAL] Yes, we can submit a copy to you. Would you like for us to mail it to you, fax it to you? And we also have an online service and we can also access a copy. You can simply go to [PII] and you can also obtain that information as well.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, so, can you fax the EOB to our fax number?
[AGENT][NEUTRAL] Yes, what is the fax.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And may I have the spelling of your name? Do I need to make it to your attention?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] It was [PII] and what was the last initial?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] No, it's [PII] is the last name.
[AGENT][NEUTRAL] OK, thank you. OK, I will get that faxed over to you and I'll put the request in to have that check traced. Is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can I get the call reference number for today's call?
[AGENT][NEUTRAL] It'll be just my name, and that's [PII] spelled [PII], last initial [PII]
[CUSTOMER][POSITIVE] Thank you so much, [PII], for assisting this claim. Have a nice day.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] You too, thank you for calling APL bye.