AccountId: 011433970860
ContactId: 190d7a65-072f-4ecf-ba3d-fac8efb8cf40
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 354970 ms
Total Talk Time (AGENT): 148446 ms
Total Talk Time (CUSTOMER): 127196 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/190d7a65-072f-4ecf-ba3d-fac8efb8cf40_20250520T13:01_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, [PII], how are you doing today?
[AGENT][POSITIVE] I'm doing well. How are you?
[CUSTOMER][NEUTRAL] Good, this is [PII] and I'm just giving you guys a call um from the provider's office of City, um, City of Sunrise Fire Rescue just to obtain claim status today on a patient.
[AGENT][NEUTRAL] OK. Well, I can definitely help you with the claim status. And may I have a, you said your name is [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK. And may I have a good contact number in case we're disconnected and the member's policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, [PII] is a good callback number direct line and the member's policy number is gonna be 01227648.
[AGENT][NEUTRAL] OK, thank you, hold on one moment.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, [PII], date of birth is [PII].
[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 and the total bill for the claim?
[CUSTOMER][NEUTRAL] Sure, it's gonna be [PII] with the $687 charged amount.
[AGENT][NEUTRAL] OK, thank you. Hold on one moment.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] And you said 1027 of 24?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Oh, I see what's happening. OK, so for this, the policy number that you gave me, um, is no longer active. It turned on [PII].
[AGENT][NEUTRAL] But they um there is an active policy. Let me give you that policy number and I'm gonna see if the claim is under that one.
[AGENT][NEUTRAL] Um, it's 256-895-6.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this has been active since [PII].
[CUSTOMER][NEUTRAL] Got you. OK, so let me say that to the patients account here.
[AGENT][NEUTRAL] And while you do that, I'm gonna check this.
[CUSTOMER][NEUTRAL] OK, so we'll update that the next time.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We have to call, we'll have the correct member ID.
[AGENT][NEUTRAL] 687 6 here it is.
[AGENT][NEUTRAL] So this is the first one.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] And can you verify the name of the provider's office, I'm sorry.
[CUSTOMER][NEUTRAL] Yes, I'm calling from City of Sunrise Fire Rescue, um, but the patient was treated at [PII].
[AGENT][NEUTRAL] I see, OK, here we go. So we received the claim twice. The first claim um we received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That claim number is 356.
[AGENT][NEUTRAL] 7256.
[AGENT][NEUTRAL] And with that claim, we made a payment of $43.45.
[AGENT][NEUTRAL] Let me see why.
[CUSTOMER][NEUTRAL] OK, so I'm assuming the other one is probably a duplicate, um.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Let me
[CUSTOMER][NEUTRAL] And with this payment that you guys made, does it show any of the payment details like if it was a check or um an EFT?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So this was a single check, let me get the check number for you, um, and with that payment, um, that payment was applied because that was all they had from their max for the year. Um, let me get the check number for you.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] So let's check number 202.
[AGENT][NEUTRAL] 9352.
[CUSTOMER][NEUTRAL] 202
[CUSTOMER][NEUTRAL] 9352.
[AGENT][NEUTRAL] And it was issued on [PII], I'm sorry, [PII].
[CUSTOMER][NEUTRAL] And 25 and you said that pay in the amount of 4345 and this is a single check.
[AGENT][NEUTRAL] Mhm. And it cleared on [PII].
[CUSTOMER][NEUTRAL] Perfect. OK, sounds good. So in reference to the balance that's here, um, this would go to the patient you're saying because they've met, um, the exponential amount for the year.
[AGENT][NEUTRAL] So, we can't determine patient responsibility because we're not a major medical insurance company, um, so it'll be whatever your, um, you know, procedures are on outstanding or remaining balances.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Got you, but just to you guys only pay the 43, 45, um, OK, sounds good.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Alrighty, well, I should be all set today, Ms. [PII] thank you so much for your help.
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Um, that'll be all today.
[AGENT][POSITIVE] Alright, well thank you so much for calling APL. I hope you have a good day.
[CUSTOMER][POSITIVE] You do the same. Thank you.
[AGENT][POSITIVE] Thank you. You're welcome. Bye bye.