AccountId: 011433970860
ContactId: 349fdd57-3c57-4415-adba-af8f2a44615f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 386760 ms
Total Talk Time (AGENT): 129860 ms
Total Talk Time (CUSTOMER): 188262 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/349fdd57-3c57-4415-adba-af8f2a44615f_20250227T19:35_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] from provider's office. I need help regarding a claim.
[AGENT][NEUTRAL] Sure I could find a claim for you. Uh, you said your name was [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][POSITIVE] Got it thank you. uh can I get a good call back number from you [PII] in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, I do have that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, just a moment, I'm checking.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I got it. Uh, the policy number is 01343212.
[AGENT][NEUTRAL] OK. And then what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] It is for [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII]. uh, what was the date of service for this claim?
[CUSTOMER][NEUTRAL] [PII]. Can you please spell your first name for me?
[AGENT][NEUTRAL] Sure, it's [PII] and I'm sorry, you did say that was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what was that billed amount, please?
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] It is for $3560.90.
[AGENT][POSITIVE] Got it. Thank you. One moment, please.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And you did say that was $3560.90. Uh, was that the amount before or after major medical paid?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It is the original bill amount.
[AGENT][NEUTRAL] OK. It does not look like we've received that claim then, [PII].
[CUSTOMER][NEUTRAL] I have the claim number. Can you please check with that?
[AGENT][NEUTRAL] Please.
[CUSTOMER][NEUTRAL] 35043559
[CUSTOMER][NEUTRAL] And also please tell me your first initial and the last name.
[AGENT][NEUTRAL] It's OK, so that bill amount that we received was $1800.19.
[CUSTOMER][NEUTRAL] A as in Alpha.
[CUSTOMER][NEUTRAL] OK, so that was only for the patient's responsibility.
[AGENT][NEUTRAL] OK, so we did pay a benefit for this claim of $1,487.49.
[CUSTOMER][NEUTRAL] Yes, actually, uh, there is the amount of $3312.70. I need to know what is for that amount.
[AGENT][NEUTRAL] OK, so that was the maximum, uh, that payment that we made, uh, met their maximum benefit amount.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] OK, and uh I want to know, can we get any EOB uh stating this all things that what is the remaining amount and what is the allowable amount because
[AGENT][NEUTRAL] So I could send you that EOB um what was that fax number for you?
[CUSTOMER][POSITIVE] OK, that's great. Fax number is [PII] and please add my name as attention.
[AGENT][NEUTRAL] Sure, I'm gonna read that number back to make sure I heard that correctly. That was [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes, you're right.
[AGENT][POSITIVE] OK alrighty I will get that sent to you um was there anything else I can help you with?
[CUSTOMER][NEUTRAL] I think that's all. And uh how is it possible that you got the total charge for this amount because from our end we have built the claim for $3560.90.
[AGENT][NEUTRAL] Uh, this is a secondary medical policy, um, we have to have that primary EOB, so this is gonna be the amount after uh the primary paid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Yes, actually that was.
[AGENT][NEUTRAL] Right, so that's what this policy helps with.
[CUSTOMER][NEUTRAL] And how many, how much time?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, can you also tell me the turnaround time for the fax?
[AGENT][NEUTRAL] Yes, um, you should get it here in maybe 10-15 minutes.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Oh, that's great.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] And the only thing I need is the call reference number.
[AGENT][NEUTRAL] Sure, reference number would just be my first name, last initial, and today's date.
[CUSTOMER][NEUTRAL] OK, so it's [PII], A as in Alpha, and 02272025.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you. I think that's all I need to do.
[AGENT][NEUTRAL] Of course.
[AGENT][POSITIVE] Alright well thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] You too bye bye take care.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII], if you don't mind, can you please check one more thing on this? Is there any patient responsibility for this claim?
[AGENT][NEUTRAL] We do not say what is patient responsibility, that would be up to the provider.
[CUSTOMER][NEUTRAL] So is there any car insurance or copay or deductible?
[AGENT][NEUTRAL] For this plan?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] No, uh, this, uh, no, it's just designed to help with co-pay, uh, co-insurance and deductible after major medical pays.
[CUSTOMER][NEUTRAL] 125
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, so the total allowed amount has been paid for this claim that was uh $1,487.49.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, thank you so much. Bye-bye. Take care.
[AGENT][POSITIVE] Of course. Thank you. Bye bye.
[CUSTOMER][NEUTRAL] And look at them