AccountId: 011433970860
ContactId: 2c3a95f6-4ca9-462d-9e00-697381ce42c5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 169800 ms
Total Talk Time (AGENT): 76350 ms
Total Talk Time (CUSTOMER): 111420 ms
Interruptions: 8
Overall Sentiment: AGENT=1.9, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/2c3a95f6-4ca9-462d-9e00-697381ce42c5_20250424T15:58_UTC.wav
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[CUSTOMER][NEUTRAL] Mhm
[AGENT][POSITIVE] Good afternoon. Thank you for, I'm sorry, good morning. Thank you for calling ATL. My name is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Good afternoon. Thank you for hi good morning. Thank you for calling ATL. my name.
[CUSTOMER][NEUTRAL] Hi [PII], I'm calling because I received the payment for a mutual patient and it looks like there's a balance remaining, but it doesn't tell me why. Um, so I was wondering if you could just look at it with me.
[AGENT][POSITIVE] I sure can look at it with you. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Can I have your name and a good
[CUSTOMER][NEUTRAL] [PII], and it's [PII].
[AGENT][NEUTRAL] Thank you for that. And [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] But.
[CUSTOMER][NEUTRAL] Sure, it is 02545381.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] And can you verify the member's first and last name and date of birth [PII] and his date of birth [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is the verification of benefits, not a guarantee of payment. So I am showing the policy is active. It's been effective since [PII]. And do you have the claim number that you want to go over together?
[CUSTOMER][POSITIVE] Thank for that and all the information provided is the verification of benefits, not a guarantee of payment. So I am showing the policy is actually been effective.
[CUSTOMER][NEUTRAL] do you have the claim number that I do um let's see here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Quick, quick number oh here 358-658-6.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] And I know that, and while you're pulling that up, I know that the plan only covers $25 but they the original balance was $30 so I just need clarification because it doesn't mention on the EOB whether you guys allow the extra $5 to be patient responsibility or not.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me see what this is, hold on one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so the $25 for the benefit used, that was the max. Um, so the $5 that's remaining, we don't determine patient responsibility because we're not the major medical, um, typically it would have been like a column on the explanation of benefits, but we were not the major medical. So that would be whatever your processes are for outstanding balances.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] $25 for the benefit.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] So the $5 that's remaining, we don't determine patient.
[CUSTOMER][NEUTRAL] Um-hum.
[CUSTOMER][NEUTRAL] We would have been like a column on the explanation of benefits but.
[CUSTOMER][NEUTRAL] The major
[CUSTOMER][NEUTRAL] So that would be whatever your processes are.
[CUSTOMER][NEUTRAL] OK, sounds good and [PII], is there a reference number for this call?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date, and the first initial to my last name is L like Larry.
[CUSTOMER][POSITIVE] So there's no call reference number, but you can use my name in today's date, and the first initial to my last name is L like Larry. Alright perfect thank you so much I appreciate your help.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] You're very welcome. Was there anything else I can help you with today? No, that's it.
[AGENT][POSITIVE] Alright, [PII], thanks for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Alright thanks for calling AP have a great day you too bye bye.