AccountId: 011433970860
ContactId: 35007f88-58c7-4e7d-b563-54e9be6b80af
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 380579 ms
Total Talk Time (AGENT): 152530 ms
Total Talk Time (CUSTOMER): 107102 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/35007f88-58c7-4e7d-b563-54e9be6b80af_20250617T13:28_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, good morning, [PII]. Um, I am calling for claim status, please.
[AGENT][POSITIVE] OK, well, I can definitely help you with the claim status. May I have your name and a good contact number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, Ms. [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] The policy number is 1826644.
[AGENT][NEUTRAL] Thank you. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Um, one.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Um, data service the range [PII] for $42,819.83.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Alright, so we received the claim twice. Um, did you want the original claim or the paid out claim?
[CUSTOMER][NEUTRAL] Um, the original claim, which, which one was paid?
[AGENT][NEUTRAL] Or both
[AGENT][NEUTRAL] So the first claim we got, we um we denied it requesting an explanation of benefits from primary and then y'all sent it in and we paid out.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] So the one that paid out, what's the claim number?
[AGENT][NEUTRAL] You want the 2nd 1? OK. Hold on one second.
[AGENT][NEUTRAL] Alright, so we received the claim on [PII].
[AGENT][NEUTRAL] That claim number is 357.
[AGENT][NEUTRAL] 12
[CUSTOMER][NEUTRAL] Uh let me get that.
[AGENT][NEUTRAL] 73
[CUSTOMER][NEUTRAL] You said 35712.
[AGENT][NEUTRAL] I'm sorry, yes ma'am. 3571273.
[AGENT][NEUTRAL] And on March, on [PII], we paid out on the claim um to the provider, a total of $3000.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you need the check number or anything?
[CUSTOMER][NEUTRAL] Um, can you tell me, did, did the patient have a responsibility?
[AGENT][NEUTRAL] So we don't determine patient responsibility because we're not a major medical insurance company. So that that's not gonna be listed on the explanation of benefits or anything. Um, it'll be up to you as a provider to determine if it'll be billed or
[AGENT][NEGATIVE] Um, written off what the next steps would be.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Is there any way that I can get a copy of EOB faxed to me?
[AGENT][POSITIVE] Yes, ma'am. What's a good fax number for you?
[CUSTOMER][NEUTRAL] It's gonna be my callback number [PII].
[AGENT][NEUTRAL] Thank you for that. And do I need to put attention, [PII]?
[CUSTOMER][NEUTRAL] Um, that's fine. It's still come directly to me.
[AGENT][NEUTRAL] OK. Well, I will go ahead and send this over to you now. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Um, was anything denied.
[AGENT][NEUTRAL] Uh, let me see.
[AGENT][NEUTRAL] Um, no, nothing was denied. The max per calendar year for outpatient and inpatient is 3000. So that full balance was applied to your claim.
[CUSTOMER][NEUTRAL] This was for the uh.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] The maximum that's um the maximum the maximum amount for the year is 3000.
[AGENT][NEUTRAL] Yes, this is their secondary policy. So for this policy, the max that we would pay out after primary is $3000. So we applied that full $3000 to your claim.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEGATIVE] If anything else get billed this year to y'all that the secondary, y'all won't pay cause he already met the max for the year.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And I am sending this explanation of benefits over to you right now, so you should be receiving it shortly. I'm just waiting to put the um fax number in here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, was there anything else I can help you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] Uh, no, um, a call reference number please.
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name and today's date, and again, that's [PII].
[CUSTOMER][POSITIVE] OK, in today's date. Thank you so much.
[AGENT][POSITIVE] Yes ma'am. You're welcome. Well, thank you for calling APL. I hope you have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.