AccountId: 011433970860
ContactId: 2bf272e9-8b51-4de6-8438-adc587f671cf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 228550 ms
Total Talk Time (AGENT): 96686 ms
Total Talk Time (CUSTOMER): 60176 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/2bf272e9-8b51-4de6-8438-adc587f671cf_20250613T14:22_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] Uh, hi, my name is [PII]. I'm calling from provider office to check on a claim status.
[AGENT][POSITIVE] OK, and I'll be more than happy to assist you with the claim status, [PII]. May I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Thank you and how many claims do you have in total today, [PII]?
[CUSTOMER][NEUTRAL] Only one.
[AGENT][NEUTRAL] Alright, and may I have the member's policy number?
[CUSTOMER][NEUTRAL] Sure, it's 02496781.
[AGENT][NEUTRAL] Thank you. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure, it's [PII], and date of birth will be [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 bills for the claim?
[CUSTOMER][NEUTRAL] Data services from 926 to 927-2024 with bill amount $600,830.94.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] 4
[AGENT][NEUTRAL] Hold on 1 2nd.
[AGENT][NEUTRAL] Alright, so I'm showing we received the claim on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 355.
[AGENT][NEUTRAL] 74.
[CUSTOMER][NEUTRAL] Uh, I have the claim number.
[AGENT][NEUTRAL] OK, how may I assist you today?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Actually, I, I want to know what are the detail on this claim.
[AGENT][NEUTRAL] OK, hold on one moment. There's no denial, this claim was paid on.
[CUSTOMER][NEUTRAL] Uh, but, uh, we sent the claim for $4,219.46 but we were only paid $3890.
[AGENT][NEUTRAL] And the the um reasoning on the explanation of benefits that the with the payment of that check it maxed out the benefits, so that's all they had left to use. So we used it all for your claim.
[CUSTOMER][NEUTRAL] So is the remaining $326329.04 is that patient responsibility?
[AGENT][NEUTRAL] We don't determine patient responsibility because we're not a major medical insurance company, so that would be up to you as the provider to the next steps.
[CUSTOMER][NEUTRAL] And is there any way to reprocess this claim?
[AGENT][NEUTRAL] Um, you, you always have the right to an appeal, but if there's no, we use all the funds for your claim, so there's nothing left to pay out. They, they use all of their benefits, but you can file an appeal if you like. There's just no more benefits left for the year.
[CUSTOMER][NEUTRAL] OK, thank you. And what is the call reference number?
[AGENT][NEUTRAL] There's no call reference number, but you can use my name in today's date. And again, that's [PII] The [PII] initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you so much for your help and have a nice day. Bye.
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Oh, that's it for today.
[AGENT][POSITIVE] Alright, thanks for calling APR. Have a great weekend. Bye-bye.
[CUSTOMER][POSITIVE] Yes, nice.