AccountId: 011433970860
ContactId: 246155bf-2b0c-4236-9651-2f1359ef6f50
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 240570 ms
Total Talk Time (AGENT): 112329 ms
Total Talk Time (CUSTOMER): 93535 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/246155bf-2b0c-4236-9651-2f1359ef6f50_20250617T18:44_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, so my name's [PII]. I'm calling from Bob Parizine Wellness Home with some questions about a, um, balance left on a claim for a member.
[AGENT][NEUTRAL] OK, sure, I can assist you with claims, Ms. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. All right. And I'm sorry, can you spell out the name of the facility one more time so I can write it down.
[CUSTOMER][NEUTRAL] B. like Baby. A. like Apple. A. like Apple. L like Larry.
[CUSTOMER][NEUTRAL] P. like Pretty. E like Eric. R like Robert. A like Apple. Z like Zebra. I like Igloo. M like Mary.
[AGENT][POSITIVE] OK, thank you. All right.
[CUSTOMER][NEUTRAL] Well,
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Go ahead, Ms. [PII].
[CUSTOMER][NEUTRAL] No, go ahead.
[AGENT][NEUTRAL] OK. Um, may I have the patient's policy number?
[CUSTOMER][NEUTRAL] D like David, 45401534.
[AGENT][NEUTRAL] Do you see a policy certificate number? It's gonna start with a 0 followed by 7 digits.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, that D number is for IMA only, it's not for us. Mhm.
[CUSTOMER][NEUTRAL] Oh, wait, I do have it.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] No, but it doesn't start with a C. It's 02.
[AGENT][NEUTRAL] 00, yeah, with a 0.0256. OK.
[CUSTOMER][NEUTRAL] 56.
[CUSTOMER][NEUTRAL] 36
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 02.
[AGENT][NEUTRAL] OK, yes. All right. And may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] It's gonna be [PII]. Date of birth is May. What was his date of birth? No, I'm sorry, [PII].
[AGENT][POSITIVE] Perfect. Do you have the claim number or do you have the date of service?
[CUSTOMER][NEUTRAL] Data services [PII] this year total bill amount $3160.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] Really
[CUSTOMER][NEUTRAL] So we received the payment of, we received the payment of 150.
[CUSTOMER][NEUTRAL] I want to know is the 2760 supposed to be the remaining balance supposed to be a write off?
[AGENT][NEUTRAL] Mm, let me check on that. More than likely it's gonna be probably members responsibility, but we're not a major medical, so in our end it doesn't go to members responsibility. It's up to the provider's discretion because we don't know if they have any other policies. This is a limited policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm. Yes, the 150 is the maximum benefit that we pay for that service. So yes, any, any remaining balance is up to the provider's discretion and we don't have any contractual involvement on the remaining because we don't know if they have any other policies. This is a limited policy. Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and so does this policy still show active?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, this one, let's see.
[AGENT][NEUTRAL] Yes, it's still showing active.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Still active.
[AGENT][NEUTRAL] Do you need any other information of the claim, like the claim number or any other information?
[CUSTOMER][NEUTRAL] No, no, it's limited benefit policy 150 was the max benefit for this. It's still active. There's no network affiliation. Can I get a call reference number?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] We don't have reference numbers, but you can use my name in today's date. Do you need the spelling of my name or any other information?
[CUSTOMER][NEUTRAL] That should be it.
[CUSTOMER][NEUTRAL] No, I can figure it out.
[AGENT][NEUTRAL] All right. Well, you have you.
[CUSTOMER][POSITIVE] Alright thank you so much you try to enjoy the rest of your afternoon.
[AGENT][POSITIVE] You as well, Ms. [PII]. Thank you for calling APL. Have a good afternoon.
[CUSTOMER][NEUTRAL] OK, mm bye bye.
[AGENT][NEUTRAL] Bye bye.