AccountId: 011433970860
ContactId: 304d0070-fc28-4f47-a352-3ea1abdc4b81
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 246429 ms
Total Talk Time (AGENT): 76103 ms
Total Talk Time (CUSTOMER): 113554 ms
Interruptions: 3
Overall Sentiment: AGENT=1.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/05/304d0070-fc28-4f47-a352-3ea1abdc4b81_20250605T20:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Lives. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII]. I'm calling on behalf of provider office. Uh, did you say your name is [PII], right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, OK. So, [PII], I'm looking for a status of the claim.
[AGENT][NEUTRAL] OK. Could I get your name and a callback number?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII]. Last initial is [PII], and the callback number is [PII].
[AGENT][NEUTRAL] Thank you. And what is the policy number you're calling on?
[CUSTOMER][NEUTRAL] OK. So the policy number is
[CUSTOMER][NEUTRAL] It is 02567172.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEGATIVE] Patient is Blam, I'm sorry, Blam, [PII].
[AGENT][NEUTRAL] Thank you for verifying the policy and you say you're calling for status. What is the date of service?
[CUSTOMER][NEUTRAL] So the date of service of this claim is.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] The total charge?
[CUSTOMER][NEUTRAL] Total charge amount is $530 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I do show the claim was received. It looks like the claim was processed and paid on December I'm sorry, [PII].
[AGENT][NEUTRAL] Uh, the maximum of $50 was paid to the provider.
[CUSTOMER][NEUTRAL] Yeah, actually, I have, uh, I'm uh I'm receiving an EOB and I found that the claim was
[CUSTOMER][NEUTRAL] Paid with the allowed amount $50 but I found that in the EOB uh the claim bill also $50 but we are billed the claim is $530.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The maximum amount allowed is $50.
[CUSTOMER][NEUTRAL] So I just found that the claim was
[CUSTOMER][NEUTRAL] OK. I understand your word, but I found, uh, actually, my concern is your bill the claim is $530. So what is the, what about the remaining balance? because in the ERA I uh reflecting on this EOB, uh, the total bill amount is $50 allowed amount is $50 and paid amount is $50.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] OK, uh, as far as patient responsibility?
[CUSTOMER][NEUTRAL] Rest of amount is, there is no information about the rest.
[AGENT][NEUTRAL] That is left up to the provider. We do not, uh, determine patient responsibility. We just pay the amount allowed for the claim. Patient responsibility is left to the provider.
[CUSTOMER][NEUTRAL] Mhm, mhm, mhm.
[CUSTOMER][NEUTRAL] So, you stated that uh the remaining amount which is left uh I'm sorry, $480 is all our patient responsibility, right?
[AGENT][NEUTRAL] I said that we do not determine patient responsibility that is left up to the provider.
[CUSTOMER][NEUTRAL] OK. So do you please confirm me, is there, you're reflecting any other active coverage of the member?
[AGENT][NEUTRAL] I do not show any other coverage.
[CUSTOMER][NEUTRAL] So you stated that you are only allowed $50 right? This is the maximum amount.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Which you allowed.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Yes, please. um, please confirm me your reference number.
[AGENT][NEUTRAL] To reference the call, you will use my name, [PII] and today's date.
[CUSTOMER][NEUTRAL] Yeah, sure, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK. Thank you so much for the information.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Have a great day.
[AGENT][POSITIVE] You have a wonderful day. Thank you for calling APL [PII].