AccountId: 011433970860
ContactId: 2d1cde68-9934-4c25-a3cb-bf649d9d89da
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 355489 ms
Total Talk Time (AGENT): 142185 ms
Total Talk Time (CUSTOMER): 113983 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/2d1cde68-9934-4c25-a3cb-bf649d9d89da_20250318T14:36_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] Um, hi, [PII]. I'm calling to check status on a claim, please.
[AGENT][POSITIVE] Sure, I'll be more than happy to help you with your claim status. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] My name is [PII]. It's spelled [PII] My phone number is [PII].
[AGENT][NEUTRAL] Thank you. And [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] Uh yes, I have a number here of.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 02221070
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII], [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 for the claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That was [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And what was the total bills?
[CUSTOMER][NEUTRAL] That would have been
[CUSTOMER][NEUTRAL] $39,481.98.
[AGENT][NEUTRAL] 98.
[AGENT][NEUTRAL] OK, and I believe I just located it. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's Christa Santa Rosa Hospital.
[AGENT][NEUTRAL] Alright, so I'm showing we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 356-8900.
[AGENT][NEUTRAL] And also on [PII], we finished processing the claim. We paid out a total of
[AGENT][NEUTRAL] $2140.81 to the provider.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Did you need that check information?
[CUSTOMER][NEUTRAL] Uh yes, please.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Alright, so it was a single check um in the amount of $2140.81.
[AGENT][NEUTRAL] Check number is 2030444.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And um,
[CUSTOMER][NEUTRAL] Uh, when was it sent out?
[AGENT][NEUTRAL] It was issued on [PII], so it's coming from [PII]. You may have not received it yet.
[CUSTOMER][NEUTRAL] OK, so we should give it a little, uh-huh, go ahead.
[AGENT][NEUTRAL] It was sent to
[AGENT][NEUTRAL] It was sent to [PII] in [PII].
[CUSTOMER][POSITIVE] Uh-huh, that is correct.
[AGENT][NEUTRAL] OK. Yes, ma'am. It was sent on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so we'll allow uh additional time for that payment to be received and it was just that single amount of the uh 2,04084. Was there any patients responsibility because we have an expected from the patient's deductible from primary of 2065629.
[AGENT][NEUTRAL] Um, hold on one moment. So we don't determine patient responsibility because we're not the major medical. The balance that was paid with the remaining balance that they had from their outpatient, their calendar year max, that's what they had left. But let me see what the max was originally.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the calendar year max for this policy is 2500. So of that 2500, um, this was what they had left, the difference between what they use and what they had and the
[AGENT][NEUTRAL] Max.
[CUSTOMER][NEUTRAL] OK, so is it whatever the, the balance is, then would that be patient's responsibility to stay max with you all?
[AGENT][NEUTRAL] Well, we don't determine patient responsibility because we're not a major medical insurance company, um, so that would be between
[CUSTOMER][NEUTRAL] So that's up to the providers.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, got it, alright um.
[CUSTOMER][POSITIVE] I think I got everything. You gave me the claim number, received and process. You gave me the check number, amount and all that good stuff. Um, may I have a reference number if there is one?
[AGENT][NEUTRAL] Sure, 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 [PII].
[CUSTOMER][POSITIVE] OK. Thank you, [PII]. Have a good day.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, you've been great. I appreciate your help.
[AGENT][POSITIVE] You're welcome, Ms. [PII]. Thanks for calling APR. Have a great day.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] You too. Goodbye.
[AGENT][POSITIVE] Thank you, bye bye.