AccountId: 011433970860
ContactId: 49e2fa10-0ac7-48ca-8022-f132e96ee2a8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 367489 ms
Total Talk Time (AGENT): 122548 ms
Total Talk Time (CUSTOMER): 104334 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/05/49e2fa10-0ac7-48ca-8022-f132e96ee2a8_20250605T12:45_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Hello, this is [PII] calling you from provider's office to check the claim status.
[AGENT][NEUTRAL] OK, [PII], you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] It's uh I'm telling you once again, it's [PII] [PII].
[AGENT][NEUTRAL] Thank you and how many claims, [PII], do you have to check status on?
[CUSTOMER][NEUTRAL] Uh I just only have one claim.
[AGENT][NEUTRAL] OK. And what is that member's policy number? I can help you with this.
[CUSTOMER][NEUTRAL] Yeah, that number is 02609441.
[AGENT][NEUTRAL] Thank you. One moment, [PII], while I get the member's information pulled up, please.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And any information, [PII], that I do provide today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, my patient's name is.
[CUSTOMER][NEUTRAL] [PII] and the date of birth is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] What is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII], and the total bill amount is $2,169.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, [PII], this claim was received on [PII]. It was processed on [PII].
[AGENT][NEUTRAL] The claim number is 360.
[CUSTOMER][NEUTRAL] So, uh, received on?
[CUSTOMER][NEUTRAL] 3 on?
[AGENT][NEUTRAL] 62.
[AGENT][NEUTRAL] Processed 64.
[AGENT][NEUTRAL] Claim number is 360.
[CUSTOMER][NEUTRAL] 62
[AGENT][NEUTRAL] 9143.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The claim, the benefit that was paid was $500 even.
[AGENT][NEUTRAL] On single check 204-840-9.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] 204-840-9
[AGENT][NEUTRAL] That is correct, and the remark on this code states the calendar year maximum for this benefit has been exhausted with the payment of this claim.
[CUSTOMER][NEUTRAL] What you have said, ma'am?
[AGENT][NEUTRAL] What I said was the calendar year maximum.
[AGENT][NEUTRAL] For this benefit.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Has been exhausted with the payment of this claim.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you need a copy of that explanation of benefits, [PII], you may print it by going to our portal at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, what is the pay date? Could you please tell me what is the pay date?
[AGENT][NEUTRAL] The same date as the process date?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, the process date. The claim number is 3609143, so it was paid on [PII].
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Yesterday, that is correct.
[CUSTOMER][NEUTRAL] So, OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Claim paid. And could you just hold for a second?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK. Thank you, ma'am. So, uh, what's your name, ma'am?
[AGENT][NEUTRAL] Again, [PII], my name is [PII], and my name in today's date will also be your call reference number.
[CUSTOMER][POSITIVE] Good
[CUSTOMER][NEUTRAL] OK, ma'am. Could you, could you please uh spell your uh spell your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. And what will be your last name initial, ma'am?
[AGENT][NEUTRAL] [PII]. And what is your last name initial?
[CUSTOMER][NEUTRAL] Yeah, ma'am. My last name is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Ma'am, uh, it's paid on. Ma'am, do you check number is this? OK. Do you have, OK, thank you, ma'am.
[AGENT][NEUTRAL] All right, [PII]. Can I help you with anything else?
[CUSTOMER][POSITIVE] Nothing, ma'am. Thank you. Have a great day.
[AGENT][POSITIVE] OK, [PII]. Well, thank you for calling APL and I hope you have a wonderful day.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Bye bye.