AccountId: 011433970860
ContactId: 079fa793-54d0-4b19-be99-872c06b84a52
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 576140 ms
Total Talk Time (AGENT): 167483 ms
Total Talk Time (CUSTOMER): 205209 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/079fa793-54d0-4b19-be99-872c06b84a52_20250313T19:01_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] from provider's office. Uh, I need to check on the claim status.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, well, I can help you with the claim status, [PII], and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I, uh, yeah, only one claim for today, yeah.
[AGENT][NEUTRAL] OK, and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yup, sure. Uh, the callback number will be [PII].
[AGENT][NEUTRAL] Thank you. May I have the member's policy number?
[CUSTOMER][NEUTRAL] Yup, sure. The member's ID will be 02258551.
[AGENT][NEUTRAL] Thank you. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure. Uh, the member's name will be [PII], and date of birth will be [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim you like me to check on?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yup, sure. The date of sales will be uh [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, um, double the amount will be $247 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] like
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Sure, uh.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Uh, the provider name or provider's office?
[AGENT][NEUTRAL] Um, the facility name?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. Um, the facility name will be Pan Mercy Hospital, [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said it's a total bill of $247?
[CUSTOMER][POSITIVE] Yep, that's right.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 247 or 297 for the total bill?
[CUSTOMER][NEUTRAL] OK, it's 247. So yeah, I'll recheck if the about the total bill on just a moment please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, sorry for the mistake. Yeah, I have mistaken the total charges are $297.
[AGENT][NEUTRAL] OK, so we received the claim.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] The claim number is 323.
[AGENT][NEUTRAL] 0257.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim to the provider, a total of $50.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So yeah.
[CUSTOMER][NEUTRAL] Uh, so the claim got paid, right?
[AGENT][NEUTRAL] Yes, we paid the benefit max of $50 towards the claim.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, uh, so can I get the, can I, may I know the amount, please?
[AGENT][NEUTRAL] Sure, hold on one moment.
[AGENT][NEUTRAL] So the benefit is up to $50.04 times per calendar year. So the $50 was applied to this claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so the allowed amount also will be uh $50 right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, then. May I know the other payment details like uh pay date and check details, please?
[AGENT][NEUTRAL] Of when the benefits were used on other claims?
[CUSTOMER][NEUTRAL] Uh, no, whether the payment was through EFT or check.
[AGENT][NEUTRAL] So it was a single check payment?
[AGENT][NEUTRAL] Um, I have the check number for you. Let me know when you're ready.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, yeah.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] Alright, so let's check number 1756564.
[AGENT][NEUTRAL] It was issued on [PII].
[AGENT][NEUTRAL] It cleared on January.
[AGENT][NEUTRAL] I'm sorry, [PII].
[AGENT][NEUTRAL] Wait a minute, hold on, I'm sorry. [PII]. It's, it's [PII]. Sorry, I had to look at the placement of the numbers.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, no issue. So it's [PII], right?
[AGENT][POSITIVE] Yes, that is cleared.
[CUSTOMER][NEUTRAL] OK, yeah, OK.
[CUSTOMER][NEUTRAL] And yeah.
[CUSTOMER][NEUTRAL] Uh, may I verify the address, please?
[AGENT][NEUTRAL] Sure, it's paid to [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, thank you so much for that, uh.
[CUSTOMER][NEUTRAL] Yeah, could you please uh wait for a moment and uh I'll check, uh, are there any other details record yet.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah, thank you so much for your patience. Uh, then I can see here, uh, the payment was not posted in our, in our system. Could you please uh send me the UB through fax?
[AGENT][NEUTRAL] Sure, I can um fax the EOB for you. What's a good um fax number?
[CUSTOMER][NEUTRAL] Yup, sure.
[CUSTOMER][NEUTRAL] Here's the fax number and it's 5854409493.
[AGENT][NEUTRAL] OK, wait. 854-409.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Uh, yeah, it's 585-4440.
[CUSTOMER][NEUTRAL] 9493.
[AGENT][NEGATIVE] There's a number missing.
[AGENT][NEUTRAL] Can you give it in a phone number status like 3 numbers, 3 numbers, and then 4?
[CUSTOMER][NEGATIVE] Uh no.
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII].
[AGENT][NEUTRAL] OK, [PII]. Hold on, hold on one second.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So that was it. OK, and then the last 4?
[CUSTOMER][NEUTRAL] 9493.
[AGENT][NEUTRAL] So 5854409493?
[CUSTOMER][POSITIVE] Yeah, that's right, that's right.
[AGENT][NEUTRAL] OK, and it's attention, [PII]?
[CUSTOMER][NEUTRAL] Yeah, uh, yeah, it's, that's right, the attention will be.
[AGENT][NEUTRAL] OK, well, I'll go ahead and fax the explanation of benefits over to you now. Was there anything else I can help with?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Man.
[CUSTOMER][NEUTRAL] Uh, no, I think that's it for this claim. Uh, could you please provide me the call reference number for this call?
[AGENT][NEUTRAL] Yes, so the call reference number will be my name and today's date. So again, that's [PII], first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK, uh.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, thank you so much, [PII], and thank you so much for your assistance. I think that's it for today.
[AGENT][POSITIVE] You're very welcome and thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Yeah. Thank you so much. Have a great day. Bye-bye.
[AGENT][POSITIVE] You're welcome bye bye.