AccountId: 011433970860
ContactId: 349438ad-575f-4e11-8674-f1d0bf88004c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1184109 ms
Total Talk Time (AGENT): 198362 ms
Total Talk Time (CUSTOMER): 118496 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=-2.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/349438ad-575f-4e11-8674-f1d0bf88004c_20250214T15:01_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling from Chavada's office. I'm checking for claim status.
[AGENT][NEUTRAL] Sure, I can assist you with claim status, Mr. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] It's [PII]. That's the direct line.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] That's 1659645.
[AGENT][NEUTRAL] It's 1659645.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Patient is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] D of service is [PII], billed for $474.06.
[AGENT][NEUTRAL] OK. [PII], the amount of 474 and 6 cents.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you. OK, I'm gonna put you on a brief hold so I can check on this claim, OK? One moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding and being patient for Ms. [PII]. Can we process the claim on [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And we send a benefit amount of $50 to the provider.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] $50. So you'll have um $850.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] You have made a payment of $50 right?
[AGENT][POSITIVE] Correct, yes. Mhm.
[CUSTOMER][NEUTRAL] And what about the remaining $10?
[AGENT][NEUTRAL] Let see.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Um, when you said there, OK, so with the payment, the maximum benefit amount for the service provided during the office visit is exhausted, so that is the maximum benefit for that office visit.
[CUSTOMER][NEUTRAL] So the $10 adjustment or you have applied it towards patient responsibility?
[AGENT][NEUTRAL] We're not the major medical. This is a secondary supplemental plan to the major medical and uh the maximum benefit is $50 per office visit. We did pay the $50 any remaining balance is up to the provider's discretion. We don't have any contractual involvement.
[CUSTOMER][NEUTRAL] Oh, OK. Um, and this payment was made through a paper check or an EFT?
[AGENT][NEUTRAL] It's gonna be a paper check, single check?
[CUSTOMER][NEUTRAL] What's that check number?
[AGENT][NEUTRAL] The check number is 2018506.
[CUSTOMER][NEUTRAL] When that check was issued.
[AGENT][NEUTRAL] The same day it was processed, which is [PII].
[CUSTOMER][NEUTRAL] And this this check cash.
[AGENT][NEUTRAL] I will have to check. I will have to search the system. Bear with me just a second. Let me see if I can find it.
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] It's still, it looks like it's still showing outstanding.
[CUSTOMER][NEUTRAL] turning so.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can you verify the address where the check was sent?
[AGENT][NEUTRAL] It was sent to [PII].
[CUSTOMER][NEUTRAL] That's the correct address.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So can you issue a check traer for this?
[AGENT][POSITIVE] Oh, I'm sorry.
[CUSTOMER][NEUTRAL] Uh, can you issue a check tracer just to know why it was not cashed? Because that's the correct address of our facility.
[AGENT][NEUTRAL] OK, I can go ahead, um, the only thing I can do is send it to the department of um business of, um, billing.
[AGENT][NEUTRAL] And uh they can check and see if it cleared again, but um we don't have, uh, I'm not sure if they can do a tracer. um.
[AGENT][NEUTRAL] So usually when it's not received within 30 days, then we cancel and reissue the check. Um, do you want us to cancel and reissue the check or do you just want us to check and see if the check, um,
[AGENT][NEUTRAL] was cleared because that's the only information we have.
[CUSTOMER][NEUTRAL] Yeah, so if this is your process to cancel and res, then you can go ahead and do that.
[AGENT][NEUTRAL] Mm, OK. So let me just send the request over Miss [PII]. OK, I'll have to put you on hold. I have to send a report. OK, one moment.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Holding and being patient for you Ms. [PII]. OK, I'll send that over and they should be able to review within 24 to 40 hours, and if it needs to be canceled, they will cancel and reissue the check, OK.
[CUSTOMER][NEUTRAL] All right. Um, can I get the claim number?
[AGENT][NEUTRAL] Yes, yes, the claim number is 3541343.
[CUSTOMER][NEUTRAL] 541-343.
[AGENT][NEUTRAL] Yes, 3541343.
[CUSTOMER][NEUTRAL] OK. And um
[CUSTOMER][NEUTRAL] Oh, can you spell your name once again, please?
[AGENT][NEUTRAL] Sure, my name is [PII].
[CUSTOMER][NEUTRAL] All right, and what will be the reference number for this call?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date.
[CUSTOMER][POSITIVE] OK, so that's it today. Thank you so much for your help. Have a great day. Bye-bye.
[AGENT][POSITIVE] You're welcome. You as well. Thank you for calling APL. Bye-bye, Mr. [PII].