AccountId: 011433970860
ContactId: 053dd7a8-3fe8-471b-901d-0805e3226718
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 478250 ms
Total Talk Time (AGENT): 147369 ms
Total Talk Time (CUSTOMER): 139211 ms
Interruptions: 3
Overall Sentiment: AGENT=1.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/053dd7a8-3fe8-471b-901d-0805e3226718_20250416T20:04_UTC.wav
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[AGENT][POSITIVE] Thank you for calling
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello, this is [PII] with APL. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I'm calling you from the provider's office and I'm looking for a claim status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status, sir. May I please get your callback number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm it's [PII].
[AGENT][NEUTRAL] Thank you. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm. This patient name, it's, uh, I'm gonna give you the policy number first, which is 1066911.
[CUSTOMER][NEUTRAL] And the patient name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, let me look that policy up real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and then may I please have [PII]'s date of service and charge amount?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] It's [PII] and the bill charge is $910 even.
[AGENT][NEUTRAL] OK, and what are the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] It's $303.87.
[AGENT][NEUTRAL] Thank you, sir. And may I get the name of the facility you're calling for?
[CUSTOMER][NEUTRAL] It's in the South Florida Surgical Specialist LLC.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I look up this claim for us, [PII], and I'll be right back.
[CUSTOMER][NEUTRAL] And your first name is [PII], right, you said?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][POSITIVE] 00, sorry. Thank you so much, sorry.
[AGENT][NEUTRAL] That's OK.
[AGENT][POSITIVE] You're welcome. It's gonna be a quick hold, sir. I'm gonna look that claim up and I'll be right back with us.
[CUSTOMER][NEUTRAL] Sure. Mhm.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] [PII], may I get that data service one more time please?
[CUSTOMER][POSITIVE] Yes, I'm with you.
[AGENT][NEUTRAL] Yes sir, what is that data service one more one more time please?
[CUSTOMER][NEUTRAL] Mhm. It's [PII] and the bill charge is $910 even.
[AGENT][POSITIVE] OK, thank you very much. I appreciate you repeating that for me. I'll be right back, sir.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh. You are on hold.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me, [PII]. So looking on data service of [PII], I do find a claim on file, but for your facility, but it's not the amount that you have given me.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] any time.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm, give me one moment. I don't know which amount you have.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Uh, so you have a billed amount for
[CUSTOMER][NEUTRAL] $635 even.
[AGENT][NEUTRAL] Yes, sir. I do.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and on
[CUSTOMER][NEUTRAL] OK, that's one of a single procedure actually.
[AGENT][NEUTRAL] On that, um.
[AGENT][NEUTRAL] Procedure, the maximum benefit for the treatment provided during this, the office visit was exhausted.
[AGENT][NEUTRAL] And it also paid $25 on the other procedure.
[AGENT][NEUTRAL] And with that payment, the maximum benefit amount for the services provided during the office visit were exhausted.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] the way
[AGENT][NEUTRAL] And I can give you that check number.
[CUSTOMER][NEUTRAL] So how much is it allowed?
[AGENT][NEUTRAL] Uh, let me check with real quick on this policy.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] $25.
[CUSTOMER][NEUTRAL] As for the benefits you guys are allowed only $25 for office visit.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Yeah. Well, the $25 which you're talking about, we have already the payment for that one.
[AGENT][NEUTRAL] OK, good. And then after that 25 was paid, it exhausted the benefit for the day.
[CUSTOMER][NEUTRAL] So this is a patient responsibility, right? the balance amount was?
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] We don't give patient responsibility. We, uh, let the, the provider determine the patient responsibility.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Why? But, but because you don't uh have the much amount for office visit.
[CUSTOMER][NEUTRAL] So this is a patient responsibility because the primary.
[AGENT][NEUTRAL] We don't
[AGENT][NEUTRAL] We always let the provider determine the patient responsibility.
[CUSTOMER][POSITIVE] OK. Sounds great. Thank you so much, [PII], for your help and assistance.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And do you have a reference number of this call?
[AGENT][NEUTRAL] Yes, sir, you can use my name and today's date.
[CUSTOMER][POSITIVE] Thank you so much for your help and assistance.
[AGENT][POSITIVE] You're very welcome, [PII]. I hope you have a wonderful day. Is that everything I can help you with?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, no, I'm done with all my questions to you.
[AGENT][POSITIVE] OK, well you have a great day and thank you for calling APL.
[CUSTOMER][NEUTRAL] C
[CUSTOMER][POSITIVE] Mhm. Bye-bye, take care.
[AGENT][NEUTRAL] Bye-bye.