AccountId: 011433970860
ContactId: 39d9d975-2a02-48cb-9e8b-ca85cdc048f8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 512558 ms
Total Talk Time (AGENT): 147121 ms
Total Talk Time (CUSTOMER): 118754 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/39d9d975-2a02-48cb-9e8b-ca85cdc048f8_20250220T17:38_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]. I'm calling for the provider Maxwell [PII]. Please note this call will be monitored and recorded for quality and training purposes, and I'm calling to check on the claim status.
[AGENT][POSITIVE] Alright, [PII], I'm happy to check on a claim status for you today. Do you have the patient's policy number?
[CUSTOMER][NEUTRAL] Um, yeah, the number is 01885462 M as in Mike, L as in Lima, number 8.
[AGENT][POSITIVE] Thank you and do you have a good call back number?
[CUSTOMER][NEUTRAL] It's [PII] and it's a direct line?
[AGENT][NEUTRAL] Thank you. May I have the patient name and date of birth?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So, the patient's name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and then what's the date of service?
[CUSTOMER][NEUTRAL] It's on [PII] and the charge amount is $1,157.98.
[AGENT][NEUTRAL] All right, thank you, one moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And date of service to confirm was [PII], correct?
[CUSTOMER][POSITIVE] Yeah, that's right.
[AGENT][NEUTRAL] I'm not showing any claims on file for that date of service.
[CUSTOMER][NEUTRAL] Um, I do have claim reference number with me. Could you please search with that as well if possible.
[AGENT][NEUTRAL] Yeah, what's the claim number you have?
[CUSTOMER][NEUTRAL] 349-545-5
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Alright, uh, so for this claim data service shows [PII].
[CUSTOMER][NEUTRAL] Just a moment please let me check in the claim form.
[CUSTOMER][NEUTRAL] I'm sorry, in the claim form, the data services [PII]. I'm sorry.
[AGENT][NEUTRAL] No, that's OK. So for this claim, but for that date of service there was a benefit payment made in the amount of $67.24.
[CUSTOMER][NEUTRAL] May I know the claim received date and the process date?
[AGENT][NEUTRAL] Uh yes, one moment please.
[CUSTOMER][POSITIVE] Sure. Thank you so much.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim was received on [PII].
[AGENT][NEUTRAL] Claim was processed on [PII].
[CUSTOMER][NEUTRAL] Um, may I know the allowed amount?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh, the benefit payment was for $67.24 on this claim.
[CUSTOMER][NEUTRAL] So is that the allowed amount as well?
[AGENT][NEUTRAL] Oh, that was the amount billed for that date of service for that claim. Let me see if there's any other claims for the uh [PII]. 1 moment.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so yeah, on this claim it looks like that was the um.
[AGENT][NEUTRAL] Amount due after the primary because we're the secondary so that was the full allowed amount of 6724 because that was the amount applied towards their co-pay and co-insurance.
[CUSTOMER][POSITIVE] All right, thank you so much.
[CUSTOMER][NEUTRAL] And may I know whether it's a check payment or an EFT payment?
[AGENT][NEUTRAL] It was a single check.
[CUSTOMER][NEUTRAL] And the check number, please?
[AGENT][NEUTRAL] 1,869,240
[CUSTOMER][NEUTRAL] And could you please help me with the check issue date and the clear date as well?
[AGENT][NEUTRAL] Uh, so the check has not been cleared. The check is still showing as outstanding.
[AGENT][NEUTRAL] And the check was issued [PII].
[CUSTOMER][NEUTRAL] All right. Thank you so much. And for this claim, could you please confirm whether the pay to address is [PII]?
[AGENT][NEUTRAL] Correct, it was sent to [PII] correct Center for bone and joint Surgery.
[CUSTOMER][NEUTRAL] And also, could you please confirm whether the patient account number is [PII] [PII]?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Could you please fax the copy of your bill?
[AGENT][POSITIVE] Yeah, absolutely. What is a good fax number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the attention to the patient's account number, please.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] All right. EOB is on its way, should be there in about 5 minutes. Is there anything else I can help with today?
[CUSTOMER][NEUTRAL] Um, no, thanks for asking. And may I know the call reference, please?
[AGENT][NEUTRAL] Call reference is going to be my name with my last initial in today's date. My name again is [PII], that's [PII] Last initial is [PII].
[CUSTOMER][POSITIVE] Thank you so much and thanks for assisting with my claim. Have a great day.
[AGENT][NEUTRAL] You too bye bye.