AccountId: 011433970860
ContactId: 229fe77a-836a-463a-9898-3fdc2b20ab85
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 369299 ms
Total Talk Time (AGENT): 90248 ms
Total Talk Time (CUSTOMER): 106083 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/229fe77a-836a-463a-9898-3fdc2b20ab85_20250618T17:46_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is Will calling you from the provider's office to check on the claim status.
[AGENT][NEUTRAL] I can help you with claim status. Can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] At [PII].
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And what's the policy number for the patient?
[CUSTOMER][NEUTRAL] Yes, uh,
[CUSTOMER][NEUTRAL] Policy number is 024.
[CUSTOMER][NEUTRAL] 13,470 M as in Mary, L as in Lima H.
[AGENT][NEUTRAL] OK give me just a moment.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth for me please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, patient name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] And what is the date of service?
[CUSTOMER][NEUTRAL] At [PII] and bill amount is.
[CUSTOMER][NEUTRAL] $5,326.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] And I have the claim number also.
[AGENT][NEUTRAL] Yeah, what's the claim number?
[CUSTOMER][NEUTRAL] It's 352.
[CUSTOMER][NEUTRAL] 9313.
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the provider's name?
[CUSTOMER][NEUTRAL] Holy Cross Hospital.
[AGENT][NEUTRAL] Alright, it looks like we paid $290.97 towards this claim.
[AGENT][NEUTRAL] And with that check, uh, the, uh, the policy maximum for the benefit had been met.
[CUSTOMER][NEUTRAL] OK, uh
[CUSTOMER][NEUTRAL] There is a uh remaining balance is there. It is $1,93.79. It needs to be billed to billed to the patient, right?
[AGENT][NEUTRAL] We don't determine patient responsibility that's up to the provider.
[CUSTOMER][NEUTRAL] OK. Uh, could you please provide me that when, uh, how, uh how many benefits the patient have and uh.
[CUSTOMER][NEUTRAL] Uh, when he made the uh benefits.
[AGENT][NEUTRAL] I'm sorry, what are you asking?
[CUSTOMER][NEUTRAL] Uh, may I know what are the benefits, uh, that patient have?
[AGENT][NEUTRAL] Give me just a moment.
[AGENT][NEUTRAL] And you're wanting the benefits for outpatient services?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, this is just a verification of benefits and not a guarantee of coverage.
[AGENT][NEUTRAL] It looks like they have an outpatient benefit maximum of up to $1250 per calendar year.
[CUSTOMER][NEUTRAL] $1250?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] And uh I see that uh he has met 4 maximum benefits uh the service.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] After we issued that check of $290 the maximum had been met.
[CUSTOMER][NEUTRAL] OK, uh
[CUSTOMER][NEUTRAL] OK. Uh, may I know what, uh what are the benefits, uh, I mean, what type of benefits the patient have?
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] The benefit maximum?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It's the $1250.
[CUSTOMER][NEUTRAL] OK, may I know when he made, uh, this amount? I mean this benefit, maximum benefit.
[AGENT][NEUTRAL] He met the benefit maximum with the payment of that check. Um, it looks like we paid that check on.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, uh, could you please spell your name for documentation purpose?
[AGENT][NEUTRAL] My name is [PII], last initial [PII]
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] Could you please provide me the call reference number and you know.
[AGENT][NEUTRAL] So we don't have call reference numbers, but you can use my name and last initial in today's date, so [PII] and then today's date.
[CUSTOMER][POSITIVE] OK, thanks for putting the information, [PII]. That's all for today. Thank you.
[AGENT][POSITIVE] OK, thank you for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] OK.