AccountId: 011433970860
ContactId: 30165873-5e8e-4f9f-bc3d-4fbcc06aae93
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 420940 ms
Total Talk Time (AGENT): 109389 ms
Total Talk Time (CUSTOMER): 188015 ms
Interruptions: 1
Overall Sentiment: AGENT=1.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/30165873-5e8e-4f9f-bc3d-4fbcc06aae93_20250207T19:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. Last name first. [PII]. I'm calling in regards to uh
[CUSTOMER][NEUTRAL] Claim status of the number. Could you please mind helping me with that, please?
[AGENT][POSITIVE] Yeah, I'm happy to check on a claim for you today. What's the policy number?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] It's uh gonna be one moment, please. That's 02476690.
[AGENT][NEUTRAL] All right, let me pull that up. One moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Please go ahead.
[AGENT][NEUTRAL] May I have the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Um, sure. That's [PII], and the date of birth, [PII].
[AGENT][POSITIVE] Thank you. And date of service?
[CUSTOMER][NEUTRAL] That's uh gonna be [PII], build the amount it's uh $2,338 even.
[AGENT][NEUTRAL] All right, thank you. One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] So we did receive a claim for the state of service. The claim was received [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There was a benefit payment sent in the amount of $50.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it looks like this is the max benefit for the state of service. This was processed [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] One moment, please. So, it's processed on [PII].
[AGENT][POSITIVE] Mhm, correct.
[CUSTOMER][NEUTRAL] Also, I just want to confirm what's the claim number, please?
[AGENT][NEUTRAL] Claim number is 3544083.
[CUSTOMER][NEUTRAL] OK. So the claim number is
[CUSTOMER][NEUTRAL] 3
[CUSTOMER][NEUTRAL] 544-083
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, I just want to confirm one thing like, uh,
[CUSTOMER][NEUTRAL] Uh, what's the total number of visits that allowed for this patient and uh visit, how much does the insurance cover? Is, is it just worth $50 for this number?
[CUSTOMER][NEUTRAL] The the station doesn't, uh, OK.
[AGENT][NEUTRAL] Yeah, 50 $50 was the next.
[CUSTOMER][NEUTRAL] OK. $50 is the max for visit. Mhm.
[CUSTOMER][NEUTRAL] Is that right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. What will be the patient responsibilities?
[AGENT][NEUTRAL] We're not able to advise on patient responsibility, that's up to the facility or provider.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, so,
[CUSTOMER][NEUTRAL] I just want to confirm like uh since the $50 is the max, max for this, the remaining that it, it should be covered by the patient, right? Since you guys will only cover this.
[AGENT][POSITIVE] That's the most that we're gonna cover. That is correct.
[CUSTOMER][NEUTRAL] OK. So the remaining will be covered by the patient, right?
[AGENT][NEUTRAL] That's up to the facility or provider to bill the patient.
[CUSTOMER][NEUTRAL] OK. Do you happen to have a copy of CUB?
[AGENT][POSITIVE] I can send you a copy of the EOB absolutely. What's a good fax number?
[CUSTOMER][POSITIVE] Thank you. That's gonna be um
[CUSTOMER][NEUTRAL] One moment, please.
[CUSTOMER][NEUTRAL] That's gonna be called the POV fax number will be.
[CUSTOMER][NEUTRAL] One moment, please. Let me go with that.
[CUSTOMER][NEUTRAL] That's [PII]?
[AGENT][NEUTRAL] It's [PII]. Is that correct?
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] Should we mark this attention to anybody?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Mm, yeah, you can just mark uh it in and attach it to me.
[AGENT][NEUTRAL] OK, that's on its way. You should be there in about 5 minutes.
[CUSTOMER][NEUTRAL] OK. So let me repeat the fax number once please to make sure I got the right one. Is it uh [PII]?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, thank you. So it will be received within 5 minutes, right? And also, I just want to confirm one thing, like in the UB which you have having, uh, does it just pay about the paid amount or does it uh uh
[CUSTOMER][NEUTRAL] Says about the remaining $2,338 as well.
[AGENT][NEUTRAL] Um, it shows the paid amount and it also shows that this was the max benefit for the date of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it doesn't uh state about the remaining.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Sure, thank you.
[CUSTOMER][NEUTRAL] One moment, please.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One moment, please.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, I have uh noted on that. Make it the call reference number, please. And uh have you already faxed it?
[AGENT][NEUTRAL] Uh yes, the fax has been sent. Call references my name with my last initial in today's date. My name again is [PII], that's [PII] My last initial is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you, [PII].
[CUSTOMER][POSITIVE] Thanks so much for your help and for any. Bye, take care. Have a nice day. Yeah, thank you.
[AGENT][NEUTRAL] You're
[AGENT][POSITIVE] You're welcome. Have a good day.