AccountId: 011433970860
ContactId: 41f3b156-d5fa-43dd-a584-1906bfc9077d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 299589 ms
Total Talk Time (AGENT): 165304 ms
Total Talk Time (CUSTOMER): 84961 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/41f3b156-d5fa-43dd-a584-1906bfc9077d_20250107T18:37_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] my
[CUSTOMER][NEUTRAL] Uh, yes, I was calling about a claim that was processed.
[AGENT][NEUTRAL] OK, are you calling from a provider's office?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I am.
[AGENT][NEUTRAL] OK, and are you wanting to check claim status?
[CUSTOMER][NEUTRAL] Well, I got an EOB and it had a weird, uh, remark on the back and so I'm not really understanding what that what that is.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, so you're just needing clarification on a on a denial?
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Remark.
[CUSTOMER][NEUTRAL] Uh, yeah.
[AGENT][POSITIVE] Yes, I can help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I apologize, what was that again?
[AGENT][NEUTRAL] Who am I speaking with?
[CUSTOMER][NEUTRAL] Sorry, there are 3 things happening. My name is [PII].
[AGENT][NEUTRAL] OK, [PII]. Thank you. And your callback number?
[CUSTOMER][POSITIVE] I do know my name I promise uh.
[AGENT][NEUTRAL] Some days I question whether I know mine or not. So, hey, I would not be judgmental at all.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is your callback number, best?
[CUSTOMER][NEUTRAL] Money.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please?
[CUSTOMER][NEUTRAL] It is 02555420.
[AGENT][NEUTRAL] OK, thank you, [PII], give me a moment to get the member's information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. So what is your patient's name please and their date of birth?
[CUSTOMER][NEUTRAL] The patient is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] OK, and what is the date of service and total bill amount for her or for him, I should say.
[CUSTOMER][NEUTRAL] Yes, Data service is 12-10-2024. The total bill charge is 275.
[AGENT][NEUTRAL] OK, and the claim number?
[CUSTOMER][NEUTRAL] 3543822
[AGENT][NEUTRAL] OK. So what does the remark read that you received?
[CUSTOMER][NEUTRAL] We are awaiting information to confirm eligibility from benefits in a card. Upon receipt of this information, we will continue processing your claim.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so yes, ma'am. So since that was sent out, we have received the confirmation of eligibility from them.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] So this claim has now been processed. It actually was processed on the [PII].
[AGENT][NEUTRAL] And the benefit has been issued. What was the total bill demand again on the claim you said 275?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, one second.
[AGENT][NEUTRAL] OK, so there has been a benefit paid in the amount of $203.
[AGENT][NEUTRAL] On this, there was one, uh-huh, 115 was paid on the [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the 0 to 10, the benefit amount was $88.
[AGENT][NEUTRAL] And it states in the remark that you will receive on this EOB will show that a portion of this benefit has been applied to your calendar year deductible.
[CUSTOMER][POSITIVE] Perfect. Alright, I had just never seen that wording on there and so I was very odd.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, that's, yes, ma'am. So that does, once we, if we review a claim and we have not received a confirmation of eligibility, that will, that is how it will go out initially.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And then as it states on there, once we do receive it, then we will continue to review so that was there was just an overlap and when you that was sent out to you and we received it and now you should be getting another EOB with that new remark, but you can also go to our portal [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And have access to the EOBs also.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] OK perfect thank you so much.
[AGENT][POSITIVE] OK. All right. Well, you are certainly very welcome. So can I help you with anything else today?
[CUSTOMER][NEUTRAL] That's everything.
[AGENT][POSITIVE] OK, well thank you again for calling APO and I hope that you have a great afternoon.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Mm uh huh bye bye.