AccountId: 011433970860
ContactId: f99877c4-70e1-4ff3-a27f-6eef83fda101
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 205729 ms
Total Talk Time (AGENT): 78177 ms
Total Talk Time (CUSTOMER): 102706 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/f99877c4-70e1-4ff3-a27f-6eef83fda101_20250604T17:57_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi there. My name is [PII]. I'm calling from provider's office, Franciscan Medical Group, regarding a patient's claim.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, yeah, I can check on that claim for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure thing, it is [PII].
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Yes, so policy number I have here is 02588042.
[AGENT][NEUTRAL] OK, and what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Member is [PII]. The date of birth is on [PII].
[AGENT][NEUTRAL] Thank you for verifying that. uh, what was the date of service for this claim?
[CUSTOMER][NEUTRAL] The date of service was on [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you have that bill amount?
[CUSTOMER][NEUTRAL] And then the amount billed was, yeah it was uh $921.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Sure thing.
[AGENT][NEUTRAL] Is this with, is it, uh, Franciscan Medical Group?
[CUSTOMER][POSITIVE] That's correct.
[AGENT][POSITIVE] OK, OK, yes, so, uh, we did receive this claim and we paid a benefit of $75.
[AGENT][NEUTRAL] And that did meet their maximum amount payable for the state of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] They met their next so I just wanted to try to get more clarifications on the because we have the the payment and the ELV um is there like, you know, patient liability or is there like an adjustment that we should be taking, yeah.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Sure, so, right, yeah, so we don't say what is patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] Up to provider, OK, um, and then the last thing I wanted to inquire is that on the patient's card it sets, uh, multi plan limited benefit. So do you guys have multi plan pricing the claims?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] So you can get with multi plan regarding that. I'm not really sure um what they do with for all that this is just their limited indemnity medical plan uh so that was just the maximum amount payable.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, OK, the plan, got it. So if you were to find out more about like what the breakdown or pricing of for these charges, we would have to reach out to multi plan.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, got it, because we are contracted with them so we'll go ahead and try to reach out with them. Thank you so much.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yeah, of course. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Uh, just say, do you guys use call reference numbers or no?
[AGENT][NEUTRAL] Yeah, yeah, it would just be my first name, last initial, and today's date. Uh so my name is spelled [PII], last initial is [PII]
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, got it in today's date, got it. OK, I will go ahead and make a note. Thank you so much for your help.
[AGENT][POSITIVE] Alright, yeah, sounds good thank you for calling AL have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.