AccountId: 011433970860
ContactId: fb1e8bc0-6b9e-47cb-8ade-9b8d19454c8f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 607229 ms
Total Talk Time (AGENT): 232952 ms
Total Talk Time (CUSTOMER): 239457 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/fb1e8bc0-6b9e-47cb-8ade-9b8d19454c8f_20250219T22:48_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is uh [PII]. I'm calling from Fountain Health Medical Center. I'm here for a claim.
[AGENT][NEUTRAL] May I please have a callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] 023 098 98.
[AGENT][NEUTRAL] And may I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. The date of birth is [PII].
[AGENT][NEUTRAL] And you were needing assistance with a medical claim?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] May I have the date of service and total bill?
[CUSTOMER][NEUTRAL] [PII]. And the total charge $24,742.80.
[AGENT][POSITIVE] And thank you for that information, [PII]. You can also check status via our secured portal that is [PII] and I'm pulling that up for you now.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Mm thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] And it looks like we did receive that claim in twice.
[AGENT][NEUTRAL] Let me get that information for you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] So for the first claim it does show that we received that one on [PII] and it was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] That claim number is 338.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 9947. It looks like the claim processed and it made a payment in the amount of $75.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And once that $75 was paid for that ER visit, that was the maximum amount that would be paid out.
[CUSTOMER][NEUTRAL] May
[CUSTOMER][NEUTRAL] $75?
[AGENT][NEUTRAL] Uh, that is correct. This is an indemnity policy, so it's a limited benefit.
[CUSTOMER][NEUTRAL] OK. Uh, what's the charge amount?
[AGENT][NEUTRAL] What do you mean what's the charge amount?
[CUSTOMER][NEUTRAL] Because, uh, as for our acceptance, the claim is, the initial claim paid is $325.
[AGENT][NEUTRAL] For the $1100 for the emergency room, it paid $75. Now, for a CT scan, it shows that it did pay a total of $250. But for the ER it paid the $75.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] ERP 75.
[CUSTOMER][NEUTRAL] And for uh the city, uh,
[CUSTOMER][NEUTRAL] It is, uh, paid amount?
[AGENT][NEUTRAL] As I stated previously, 250.
[CUSTOMER][NEUTRAL] 250. OK. That's a total 325. OK. But that's just too much loan amount because this is an ER uh.
[CUSTOMER][NEUTRAL] Uh, you guys accept the.
[AGENT][NEUTRAL] And this policy is an indemnity policy, so it's a limited benefit. That is the maximum amount that would be paid out.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Danity policy. OK. So you guys accept the NSA, uh, no surprise act uh the ID, sir?
[AGENT][NEUTRAL] There is no surprise act. This is just the policy that the member has.
[CUSTOMER][NEUTRAL] Open negotiation.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This is an indemnity, which is what I'm advising is the um, OK, let me explain this to you.
[CUSTOMER][NEUTRAL] OK. No, no, my.
[CUSTOMER][NEUTRAL] Uh, OK.
[AGENT][NEUTRAL] Any other information the only thing that I can disclose to you about this claim is the amount that was paid out or any other information. Now this member knows what type of policy that they have, so that is the amount that we will only pay out.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK. We, that's not too much low amount you guys pay. So the rest of the balance uh we send the patient.
[AGENT][NEUTRAL] It is the provider's discretion. We can't tell the provider how to bill.
[CUSTOMER][NEUTRAL] OK. So it's depending on the provider.
[AGENT][NEUTRAL] Yes, it's the provider's discretion.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, OK. Can you provide me the second claim number?
[AGENT][NEUTRAL] Yes, the second claim number is 3485299. For that claim is denied as a duplicate of the previous submitted claim.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] 5299.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I got it. 3485299.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, I got it. Uh, thank you. Can you please share the copy of PV of this claim?
[AGENT][NEUTRAL] Which one, the first one or the second one?
[CUSTOMER][NEUTRAL] Uh, bought one.
[AGENT][NEUTRAL] You're needing the duplicate and the previous paid claim.
[CUSTOMER][NEUTRAL] Yes, because we need to discuss with the doctor. Yeah, the fax number is 602.
[AGENT][NEUTRAL] May I have the fax number?
[CUSTOMER][NEUTRAL] 883
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And let me make sure this is correct, [PII].
[CUSTOMER][POSITIVE] Yeah, perfect.
[AGENT][NEUTRAL] Attention
[CUSTOMER][NEUTRAL] [PII], my name.
[AGENT][NEUTRAL] OK, and is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Hi, yes, I have one more claim for the same date of service and a different, uh, charge mode because emergency room send two bills. One is for facility and one for professional.
[AGENT][NEUTRAL] OK, may I have that total bill?
[CUSTOMER][NEUTRAL] The total bill is $2,082.52.
[AGENT][NEUTRAL] You said 52 cents?
[CUSTOMER][NEUTRAL] Yeah, 52.
[CUSTOMER][NEUTRAL] So you have an other updated ID.
[CUSTOMER][NEUTRAL] You're saying that uh you also to update for the insurance, right?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] I'm pulling that up for you now.
[CUSTOMER][POSITIVE] Mm, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] I receive payment from our side.
[CUSTOMER][NEUTRAL] And then.
[AGENT][NEUTRAL] And for that claim it does show that we did receive that claim in and it shows that the maximum amount for the date of service has been met and the receipt date for that claim is [PII] and it was processed on [PII], so it's showing that the max has been met for that member.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Claim ID?
[AGENT][NEUTRAL] The claim number is 3389953.
[CUSTOMER][NEUTRAL] 53. OK, I got it. I only need the copy of your big that one.
[AGENT][NEUTRAL] OK, and is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEGATIVE] No, thank you. That's not on time that uh you'll be receiving.
[AGENT][NEUTRAL] It can take up to 24 to 48 hours before the EOB is received.
[CUSTOMER][NEUTRAL] OK, so you just uh send a request, not sending yet, right?
[AGENT][NEUTRAL] Correct. Now you do have the option if you would like to receive it quicker, you have the option to go on to the security portal and you will be able to download that EOB.
[CUSTOMER][NEUTRAL] OK, can you please provide me the uh your link?
[AGENT][NEUTRAL] That secured portal is secured SEC.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] You are
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, secure. [PII]. OK, uh, just a moment. I just searching on it.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII] This require any uh login?
[AGENT][NEUTRAL] You do have to set up a username and password.
[CUSTOMER][NEUTRAL] OK. May I have your reference ID?
[AGENT][NEUTRAL] Yes, the reference number will be my first name [PII], which is spelled [PII] last initial of [PII] and today's date.
[CUSTOMER][NEUTRAL] We do book are there there is something that you have this and really so that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. [PII]
[AGENT][NEUTRAL] [PII] as in [PII] for the first letter.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] I A.
[CUSTOMER][POSITIVE] I, OK, got it. Thank you. Thank you for your kind information.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life. Have a great day, Mr. [PII].
[CUSTOMER][NEUTRAL] Mhm. Yes, ma'am. Bye-bye.