AccountId: 011433970860
ContactId: 128884d6-54c0-47cc-a306-a1e736aa114e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 552880 ms
Total Talk Time (AGENT): 242530 ms
Total Talk Time (CUSTOMER): 108699 ms
Interruptions: 0
Overall Sentiment: AGENT=2.4, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/128884d6-54c0-47cc-a306-a1e736aa114e_20250127T20:42_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, good afternoon. I'm [PII] calling you from provider's office to check on claim status.
[AGENT][POSITIVE] Oh, I'd love to help with claim status, and for my notes, would you mind spelling your name for me, please?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][POSITIVE] Thank you, I appreciate that. And is it [PII]? Am I, how do you say it again?
[CUSTOMER][POSITIVE] Uh yes, exactly.
[AGENT][POSITIVE] Oh perfect. OK, thank you. And um Passa, what's that call back number for you my friend?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Perfect and the policy number for the claim we wanna check on?
[CUSTOMER][NEUTRAL] Sure, before proceeding further, I would like to inform you that this call is getting recorded for quality and training purposes. Member ID is going to be 017.
[CUSTOMER][NEUTRAL] 31964
[AGENT][POSITIVE] Perfect, and I will start getting that policy pulled up for you, sir. Give me one second.
[CUSTOMER][NEUTRAL] Mhm and can you please spell your name for me as well?
[AGENT][NEUTRAL] You betcha. It's [PII], [PII], first initial, last name, [PII].
[CUSTOMER][POSITIVE] Perfect. Thank you so much, [PII].
[AGENT][NEUTRAL] My pleasure, and I was able to get that policy pulled up. Would you mind verifying for me, please, your member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII], [PII].
[AGENT][NEUTRAL] Perfect. I do see her here and is there a particular claim number you want to look at today, or we were did you wanna search by data service?
[CUSTOMER][NEUTRAL] Uh, by date of service it's [PII] with $500 even.
[AGENT][POSITIVE] Perfect. [PII]. Awesome and give me just a moment on that one, my friend.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And that $500 was that the total charge after primary or was there a different charge after primary, my friend?
[CUSTOMER][NEUTRAL] Sure, let me check. After primary, it is $348.07.
[AGENT][NEUTRAL] 3
[CUSTOMER][NEUTRAL] No, no, it's $398.07 sorry.
[AGENT][NEUTRAL] No worries, thank you. Alright, so I have a lot of claims I need to check out if you don't mind bearing with me one second.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] What is the name of the facility on file for this claim?
[CUSTOMER][NEUTRAL] It's going to be diagnostic Center for Women LLC.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] like
[AGENT][NEUTRAL] Just one more second, my friend. I think I found it, but I just want to verify.
[CUSTOMER][NEUTRAL] you
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] All right, yes, this is your claim. Thank you so much for your patience while I got that all verified. Let me get those details for you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] I do show that your claim number is 342, I'm sorry, 3472745.
[CUSTOMER][NEUTRAL] Hm?
[AGENT][NEUTRAL] I show we received your claim on [PII]. We processed the claim on [PII], and I am showing that the claim had benefits payable of $250. That was going to be made with a single check. Your check number is 1859189.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] And it looks like that check was um made for diagnostic Center of Miami LLC on [PII] and the check was cashed on [PII].
[CUSTOMER][NEUTRAL] All right, [PII]. Thank you so much for that information. May I know why the only, the, I mean, APL only paid $250 for this claim even though the member responsibility was 398.07?
[AGENT][NEUTRAL] Yeah, let me see if I have that on hand for you. Give me one second.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] All right, so actually for that my friend I'm really sorry I would have to transfer you to um a claims examiner to go over that information with you. Would that be OK?
[CUSTOMER][POSITIVE] Sure, not a problem.
[AGENT][NEUTRAL] OK perfect I'm gonna put you on a brief hold and let me get somebody on the line OK?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Conferring.
[CUSTOMER][NEUTRAL] This is [PII].
[AGENT][NEUTRAL] Hi [PII], this is [PII] from the care team. How are you doing today?
[CUSTOMER][POSITIVE] I'm great how are you?
[AGENT][NEUTRAL] Hey, I'm so wonderful, thank you for asking. Hey there, I have a provider on the line, um, he called for claim status, and he just has a question I can't answer. We're looking at policy number 1731964.
[CUSTOMER][NEUTRAL] OK and the provider's name?
[AGENT][NEUTRAL] His name is [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and his callback number is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] He called and verified [PII] part one and we're looking at claim number 34.
[AGENT][NEUTRAL] 72745
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I did tell him about the benefits payable. He wants to know why, um, the claim only paid for 250 when patient responsibility was the 298 and change, but I don't have any denial codes on here, so I can't, uh, read anything off to him.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] I'm pretty sure it's because we don't cover the administrative fees, but I just, I, it's like, you know what I mean, I'm just not trained, so I don't wanna say anything and get.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, no worries. I got them. So wait a minute. Yes, this is Metlink. OK, I had to make sure.
[AGENT][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] OK, I'm ready.
[AGENT][NEUTRAL] All right, and I'll I'll introduce you, Ms. [PII] when we join, OK?
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] My pleasure.
[AGENT][NEUTRAL] Hi [PII], are you still there with us?
[CUSTOMER][NEUTRAL] Yes, I'm here.
[AGENT][POSITIVE] Hey, thank you for your patience. I have Miss [PII] on the line, um, and she's gonna be able to help you look at that claim a little further and figure out why it didn't cover that whole, um, patient responsibility, OK?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Alright, thank you so much I will be uh Eli mhm.
[CUSTOMER][NEUTRAL] Hello