AccountId: 011433970860
ContactId: f3419c72-5539-47fc-91c9-de9fb1ffdbcf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 519158 ms
Total Talk Time (AGENT): 190122 ms
Total Talk Time (CUSTOMER): 372595 ms
Interruptions: 21
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/f3419c72-5539-47fc-91c9-de9fb1ffdbcf_20250227T14:18_UTC.wav
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[AGENT][POSITIVE] Good morning thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] again. I just book, uh, call you back right now from Baja Hospital.
[AGENT][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Yes, and the callback number?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII]. Uh.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] All right, thank you, [PII]. And how can I help you this time?
[CUSTOMER][NEUTRAL] Yeah, I have to, uh, verify on the same claim, uh.
[CUSTOMER][NEUTRAL] Some clarification on the savings plan.
[AGENT][NEUTRAL] What is
[AGENT][NEUTRAL] Oh sure, I can help you with that, [PII]. What is that claim number?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh, claim number is 3472475.
[AGENT][POSITIVE] All right, thank you. For [PII].
[CUSTOMER][NEUTRAL] Yes, yeah. Yeah, uh, yes, yes, yeah. So I need, I need a clarification that if the claim is processed towards the network or out of network.
[AGENT][NEUTRAL] OK. Yes, I remember and you gave us a dental policy and we found that medical policy for her. Yeah, OK.
[AGENT][NEUTRAL] All right, and
[AGENT][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] So the policy participates in the multi-plan network, but there's no contractual involvement in our processing of the claim that is strictly through multiplan.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, fine. And OK, fine. And also you stated that another claim which we have received $500 for the same budget hospital, right?
[AGENT][NEUTRAL] So we do not reprice claims.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Yeah. Is that, uh, can you provide me the claim number of, uh, means the account number to which claim it has been paid?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, because we, they are stating that, uh, maybe this can be processed as split bill, right?
[CUSTOMER][NEUTRAL] In the $7,456.50 they may ask for the patient's policy you said, they'll pay only $500. So, may, they may have split the bill up to $500 and they have paid and the remaining, they may have divided, uh, denied as maximum benefits has been exhausted.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's correct. So for the claim that was processed and paid for the amount of $7,376.76 for Burger Hospital, is that the account number you need?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEGATIVE] No, no, no.
[CUSTOMER][NEUTRAL] $7,456.50.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, you need the account number?
[AGENT][NEUTRAL] On that claim,
[CUSTOMER][NEUTRAL] Yeah, 344-053-5 is the pay claim number, right? Yeah, I need the account number of that. Yeah.
[AGENT][NEUTRAL] That's the paid claim number, yes, sir.
[AGENT][NEUTRAL] For the paid claim. The patient's account number is 432.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 405.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 909.
[AGENT][NEUTRAL] 0100.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, so it is the same claim, right?
[AGENT][NEUTRAL] Well, the amount, the total amount billed is different, but that's the pay claim.
[CUSTOMER][NEUTRAL] Yeah, they have, yeah, yeah, I understand that. Uh, since you will pay only $500 per day, they have split the $7,456.50 into two, right? One for $500 and another $6,956.50 is denied as maximum benefits has been exhausted as per patients plan, you will pay only $500.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEGATIVE] OK, fine. So, uh, actually, we haven't received um
[CUSTOMER][NEUTRAL] Uh, the EOB.
[CUSTOMER][NEUTRAL] Of maximum benefits exhausted. So is that possible? Can you fax that to you?
[AGENT][NEUTRAL] I can, [PII]. Now, there, mhm, there's a quicker way to get that EOB and I can help you with that. We do have a provider portal.
[CUSTOMER][NEGATIVE] The denied one.
[CUSTOMER][NEGATIVE] The denied one.
[CUSTOMER][NEUTRAL] Mhm mhm.
[AGENT][POSITIVE] I can assist you to create an account and you'll have that EOB automatically.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If you will go to secured, that's [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII]. OK.
[AGENT][NEUTRAL] Mhm, if you go in as a new user.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] One moment, it's loading.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. Employer, OK.
[AGENT][NEUTRAL] And if you
[AGENT][NEUTRAL] Yeah, you're gonna choose you're an employer, I mean, uh, a provider, a medical provider, it's the last question. Put in your tax number and let me give you the patient account number on the denied claim.
[CUSTOMER][POSITIVE] Yeah, I got it.
[AGENT][NEUTRAL] Tell me when you're ready.
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] Yeah, one moment.
[CUSTOMER][NEUTRAL] You know.
[CUSTOMER][NEUTRAL] It's loading.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] OK, the patient account number on the denied claim is 432.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 405.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 909.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 0102.
[AGENT][NEUTRAL] And then it'll ask you to create an account with the user name and password.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] I'm doing it. One moment. Thank you.
[AGENT][POSITIVE] OK, take your time.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] I'm a.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] I'm, I'm just gonna.
[CUSTOMER][POSITIVE] Alright for you
[CUSTOMER][NEUTRAL] and not the
[CUSTOMER][NEUTRAL] You got something you do the same for.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] O.
[CUSTOMER][NEUTRAL] 400
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] I'm giving the same password but it shows password.
[AGENT][NEUTRAL] Are you using one lower case, one uppercase, one number, and one symbol?
[CUSTOMER][POSITIVE] Yeah. Yeah, just getting submitting. Yeah, I can that has been successfully created. Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so if you will sign in and I'll I'll show you how to get that EOP.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh, yeah. Mhm.
[AGENT][NEUTRAL] Once you're signed in if you'll go to the quick access.
[AGENT][NEUTRAL] You're gonna put in the patient's first name and her date of birth, and then the claim number.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] OK, first name.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 75
[CUSTOMER][NEUTRAL] OK. Yeah, I got the claim.
[AGENT][NEUTRAL] OK, and so now that you've got that account, [PII], you've got 24/7 access to claim status. If you don't have the claim number, you can use option 2.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If you do have the claim number, you have 24/7 access to EOBs as well, and you can submit claims online as well.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] On that portal.
[CUSTOMER][POSITIVE] Sure, thank you. OK. That's so nice of you and thank you. Thanks for the help. Have a great day. Bye-bye. Thank you.
[AGENT][POSITIVE] It's been my pleasure to assist you. Again, [PII]. I hope you have a wonderful day.
[CUSTOMER][POSITIVE] Thank you. You as well.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Right, right.