AccountId: 011433970860
ContactId: 33d49a0d-f45c-4e87-9af9-5153b85ca5a8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 351239 ms
Total Talk Time (AGENT): 147332 ms
Total Talk Time (CUSTOMER): 102351 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/33d49a0d-f45c-4e87-9af9-5153b85ca5a8_20250113T20:27_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon, [PII]. My name is [PII]. How are you today?
[AGENT][NEUTRAL] I'm, I'm fine, but I'm so sorry. What did you say your name was?
[CUSTOMER][POSITIVE] No worries [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, [PII], thank you so much. And how can I help you today?
[CUSTOMER][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] I'm just calling for a claim status for a patient of ours, please.
[AGENT][NEUTRAL] OK, you're needing claim status for one patient, is that correct? Yes, ma'am. I can help you with that. And We [PII], what is your callback number?
[CUSTOMER][POSITIVE] Yes please, correct.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, 2, give me one second, I'm so sorry. I don't know those.
[AGENT][NEUTRAL] Sure. No, you're fine. You're fine.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 84442.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] 01823110.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Uh, her name is [PII] and her date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her, please?
[CUSTOMER][NEUTRAL] Date of service is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the total bill amount was $7,701.78.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So the most recent received, we've received this claim more than once. The most recent one was denied as a duplicate of previously submitted expenses. Do you need that information or just the original claim received?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] The original, the one that was uh that was uh I believe you guys made a payment on it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Bear with me, please, [PII] I'm sorry.
[CUSTOMER][POSITIVE] Of course, take your time, no worries.
[AGENT][NEUTRAL] Do you already have the claim number?
[CUSTOMER][NEUTRAL] Um, uh, I can provide, I think it might be this 1 352.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 7866.
[AGENT][NEUTRAL] Yes, ma'am. OK.
[AGENT][POSITIVE] And then how can I help you with that one?
[CUSTOMER][NEUTRAL] Um, I just wanna, uh, um, a payment breakdown of what was allowed, if there was any patient responsibility applied and any adjustments made.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so this is a supple we are not a major medical insurance. This is only a supplement to the primary insurance, so there's not any type of contractual agreement on this plan. The benefit did pay $500 and with this check, the maximum benefit payable for this date of service has been met.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Was there a patient responsibility applied or is just that's as much as
[AGENT][NEUTRAL] Oh, and no, we do not determine responsibility uh excuse me, if we do not determine patient responsibility, [PII], that would be up to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, understood.
[AGENT][NEUTRAL] And then we also do your you may already have our portal website, but if you need a copy of this explanation of benefits you can go to our portal at [PII].
[AGENT][NEUTRAL] To get that.
[CUSTOMER][POSITIVE] Perfect. OK.
[CUSTOMER][NEUTRAL] Um, and [PII], uh, would you be able to provide me the date when this was processed, please?
[AGENT][NEUTRAL] Mhm, one moment.
[AGENT][NEUTRAL] This claim was processed on [PII].
[CUSTOMER][POSITIVE] Perfect. OK, and lastly, can I just bother you for a reference number please?
[AGENT][NEUTRAL] Sure, you would use my name along with today's date.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Awesome, [PII] thank you so much for your time and your help today I appreciate it.
[AGENT][POSITIVE] Well, absolutely, you are very welcome. And is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] No ma'am, that'll be all. Thank you.
[AGENT][POSITIVE] OK. Well, thank you so much. You're welcome. Thank you again for calling APL and I hope that you have a very nice evening.
[CUSTOMER][NEUTRAL] You as well bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.