AccountId: 011433970860
ContactId: f94d0e26-0c93-4d33-a373-b35ddf34db07
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 826929 ms
Total Talk Time (AGENT): 226345 ms
Total Talk Time (CUSTOMER): 240505 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/f94d0e26-0c93-4d33-a373-b35ddf34db07_20250203T15:13_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, so, good afternoon. My name is and I'm calling from Eastco Regional Medical Center LLC to check on a claim status for quality and training purposes. Discorded and monitored.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status, and I'm sorry, I didn't quite catch your name. Can you repeat your name?
[CUSTOMER][NEUTRAL] Uh yes. I, my name is [PII] and it's spelled [PII] is [PII]. And I'm sorry, could you spell your name for me as well?
[AGENT][NEUTRAL] Sure, that's [PII].
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][POSITIVE] You're welcome. And may I have a callback number just in case we get disconnected?
[CUSTOMER][POSITIVE] Yes, thank you. My direct phone number is [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, thank you. The policy ID number is 0259909.
[AGENT][POSITIVE] OK. Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And, um, do you have the copy of the card?
[CUSTOMER][NEUTRAL] Um, no, I don't.
[AGENT][NEUTRAL] OK, this number is missing a digit. Um, do you want to repeat it again just to make sure I got it correctly? Yes, it's missing one digit.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, sure, the member ID number is 025099909.
[AGENT][NEUTRAL] Oh, OK. I was missing a 0. Thank you. OK, what's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes, thank you. The patient's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, perfect, thank you. And may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] You're welcome. The date of service is January, I mean [PII], and the total bill amount is $73,281.94.
[AGENT][NEUTRAL] Thank you. All right, let me see if I have this claim, and that was [PII], correct?
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome. OK.
[AGENT][NEUTRAL] OK, and for future, you can check claim status online through our website at [PII] and that's just optional. And let me pull the EOB.
[CUSTOMER][POSITIVE] Sure, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so it looks like we processed the claim on [PII].
[AGENT][NEUTRAL] And we send a benefit amount of $3,083.10 with the payment of that check, it looks like the impatient maximum for the calendar year has been met.
[CUSTOMER][NEUTRAL] OK. So the, um, what you call this? APL paid for $3000 if I read the pay responsibility.
[AGENT][NEUTRAL] We paid $3,083.10.
[CUSTOMER][NEUTRAL] Oh, sorry.
[CUSTOMER][NEUTRAL] $3,083.10. So with no special responsibility, right?
[AGENT][NEUTRAL] Um, we are not the major medical, so we don't have patients responsibility. Um, out of the amount that it was applied towards the deductible, we pay $3,083.10. So any remaining balance is up to the provider's discretion. We don't have any contractual involvement in the remaining, um, but the reason we pay the $3,083.10 is because with that check, uh, the maximum benefit for the inpatient has been met.
[CUSTOMER][NEUTRAL] Did they?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. OK, um, for this one, since you mentioned that, uh, the maximum benefits have been, uh, have been met, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] How much is the annual?
[CUSTOMER][NEUTRAL] Um, amount for the claim or for, of the patient for
[AGENT][NEUTRAL] OK, sure. Mhm. Yes, um, the calendar year maximum for this member is $5000 per year.
[CUSTOMER][NEUTRAL] OK, 5000 per year.
[AGENT][NEUTRAL] Mhm. Yes.
[CUSTOMER][NEUTRAL] OK, and that's the patient policy.
[CUSTOMER][NEUTRAL] Maximum or annual benefits.
[AGENT][POSITIVE] Correct, yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This is not a guarantee of payment, just a verification of coverage.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, just a moment, let me document that one T-shirt has annual benefit.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For the
[CUSTOMER][NEUTRAL] Amount of 5000 per year.
[CUSTOMER][POSITIVE] Thank you so much. And uh is the remaining balance, is it responsibility?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's up to the provider's discretion because we, yeah, we're, we're not the major medical, so we do not apply anything to towards the member's responsibility.
[CUSTOMER][NEUTRAL] Since
[CUSTOMER][NEUTRAL] OK. So the remaining balance is the official responsibility.
[AGENT][NEUTRAL] No, it's up to the provider's discretion. We cannot tell you what to do with that remaining balance, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, may I have the
[AGENT][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello?
[AGENT][NEUTRAL] I cannot hear you. I can hear you now, Miss [PII]. OK, go ahead.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK. Um, may I have the claim number?
[AGENT][NEUTRAL] Sure, the claim number is 3,548,870.
[CUSTOMER][POSITIVE] OK, thank you so much. And may I request for a copy of the explanation of benefits?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Sure. Mhm. What is the fax number?
[CUSTOMER][NEUTRAL] Thank you so much. The fax number is [PII]. And so, uh please attention that you'll be copied to my supervisor. His name is [PII] and it's spelled [PII] for [PII]. Last initial is [PII], with patient account number for tracking [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. All right. Uh, and that's [PII] Atten END and then uh patient's account number 027433168. Will you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][NEUTRAL] Oh, I'm sorry, the line was getting in and out. Um, just to confirm for the fax number, is it [PII]?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, that is correct. Yes, mhm.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] OK. You're welcome. Can you hold for me while I send this back to you or to, to your supervisor?
[CUSTOMER][POSITIVE] Sure, no worries.
[AGENT][NEUTRAL] OK, thank you, one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me, Ms. [PII]. OK, I went ahead and send that over to your supervisor. Is there anything else I'm gonna help you with today?
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] Oh yes. How many hours do you need to allow for it to receive?
[AGENT][NEUTRAL] I'm sorry, how many what?
[CUSTOMER][NEUTRAL] Uh, how many hours, uh, we need to allow for it? Uh, do we need to allow 24 hours for it to receive?
[AGENT][NEGATIVE] Oh, no, no, no. In a few minutes, um, it, it doesn't take more than 15 minutes for you to get in.
[CUSTOMER][POSITIVE] OK, thank you so much. And uh do you have a call reference number, so?
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][POSITIVE] OK, um, that would be all. Thank you again. So for the information for assisting me. Stay safe and have a great day. Happy Monday.
[AGENT][POSITIVE] You're welcome. No problem.
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] You as well, Miss. Thank you for calling APR. Have a great week. Mhm. Thank you. Bye-bye.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Bye bye.