AccountId: 011433970860
ContactId: 223f1fca-adde-4c15-a122-75f5368c3f33
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 411079 ms
Total Talk Time (AGENT): 99760 ms
Total Talk Time (CUSTOMER): 135763 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/223f1fca-adde-4c15-a122-75f5368c3f33_20250210T16:07_UTC.wav
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[AGENT][NEUTRAL] This is [PII].
[CUSTOMER][NEUTRAL] Hi Ay, this is [PII] over on the care team. How are you?
[AGENT][POSITIVE] I'm good. How are you?
[CUSTOMER][NEUTRAL] Doing all right thank you. I have a provider on the line calling regarding a uh medlink claim um we did pay the full benefit. She's stating that uh she believes that there were items missing, um, that we should have been able to pay and wants to take a closer look at that.
[AGENT][NEUTRAL] OK. And her name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And her callback number?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK. And the policy number?
[CUSTOMER][NEUTRAL] That is 2300701.
[CUSTOMER][NEUTRAL] And it is for uh part two.
[CUSTOMER][NEUTRAL] And I've got that claim number that we're looking at too.
[AGENT][NEUTRAL] OK. What's the claim number?
[CUSTOMER][NEUTRAL] It is 3451167.
[AGENT][NEUTRAL] 45
[AGENT][NEUTRAL] OK, I have it pulled up. You can send her over.
[CUSTOMER][POSITIVE] Alright appreciate it thank you.
[AGENT][POSITIVE] Mhm, no problem.
[CUSTOMER][NEUTRAL] Tell me exactly what
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um, I was on hold. Was I transferred to you?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, um, I was speaking to [PII].
[CUSTOMER][NEUTRAL] On this particular date of service and we received payment for the copay, but I have deductible and co-insurance still outstanding.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Yes, ma'am. I could further assist you. First, could you please verify the patient's name and date of birth one more time?
[CUSTOMER][NEUTRAL] Yeah, let me get to my screen.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] It's [PII] [PII].
[AGENT][NEUTRAL] OK. And the date of service and bill charges on the claim?
[CUSTOMER][NEUTRAL] Uh, was [PII].
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, could I get the date of service and bill charges one more time?
[CUSTOMER][NEUTRAL] Sure, um, [PII].
[AGENT][NEUTRAL] OK. Yes, ma'am. I'm showing that this paid out for $500 even and according to the documentation we received, um, the claim paid out in full. We cover the copay, the co-insurance, and the deductible. And I'm showing, according to what we received, it paid out in full. You're saying that there are uh there are additional charges?
[CUSTOMER][NEUTRAL] No additional charges.
[CUSTOMER][NEUTRAL] We received the payment from from you for um $500. That's the copay.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][MIXED] OK, but the deductible and co-insurance are still outstanding.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And that was all on the explanation of benefits from Aetna.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment, I'm opening up the documentation to take another look. One moment.
[CUSTOMER][NEUTRAL] Like the co-insurance is $71 and the deductible is $1550.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK. Yes, ma'am. Thanks for your patience. OK, yeah, I'm showing that it showed that it paid out that amount because under this policy, we only cover up to $2500 per calendar year and that benefit maximum was reached and that's why there was only $500 left um to pay these benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So the benefit max was reached.
[AGENT][NEUTRAL] Yes, ma'am, for the calendar year.
[CUSTOMER][NEUTRAL] So the, the.
[CUSTOMER][POSITIVE] So the member owes it.
[AGENT][POSITIVE] Yes, ma'am. That's correct.
[CUSTOMER][NEUTRAL] OK, all right, um, how, how are you spelling your name for my records?
[AGENT][NEUTRAL] Um, it's spelled [PII] and my last initial is [PII]. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, do you give a call reference number?
[AGENT][NEUTRAL] You can use my name and today's date for the reference number.
[CUSTOMER][POSITIVE] OK, all right, that's all I needed thank you so much.
[AGENT][POSITIVE] OK. I thank you [PII] for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][POSITIVE] Mm. You're welcome.