AccountId: 011433970860
ContactId: 4bbbc1ab-1791-4348-8171-c21af61a78a5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 333779 ms
Total Talk Time (AGENT): 102457 ms
Total Talk Time (CUSTOMER): 69189 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/4bbbc1ab-1791-4348-8171-c21af61a78a5_20250611T14:06_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, I want to see if you could look, I'm a provider I want to see if you could look at a claim that was paid on.
[AGENT][NEUTRAL] Um, yes, ma'am. I
[CUSTOMER][NEUTRAL] And just explain to me a little bit about the patient's plan.
[AGENT][NEUTRAL] Yes, ma'am. I can assist you with claim status. Um, first, could I get your name and a good callback number?
[CUSTOMER][NEUTRAL] It's [PII] [PII] and [PII]'m [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now, could I get the policy number, please?
[CUSTOMER][NEUTRAL] It is 02279407.
[CUSTOMER][NEUTRAL] For [PII].
[AGENT][NEUTRAL] OK. Thank you. Now, please verify her date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And what's the date of service and bill charges on the client?
[CUSTOMER][NEUTRAL] It is 37 of $25 in the amount of $8,146.
[AGENT][NEUTRAL] OK, one moment, please.
[CUSTOMER][NEUTRAL] And I'm sorry, what was your name?
[AGENT][NEUTRAL] Um, it's [PII], um, it's spelled [PII] and my last initial is [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] OK. Yes, ma'am. This is for the facility charges for the surgery center.
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] I just wanted to understand if it was like, like they only pay up to so much and the remaining is patient responsibility is it like a gap or an intended the plan or I'm I'm unsure.
[AGENT][NEUTRAL] Um, yes, ma'am. It's a gap insurance plan, um, for outpatient services. Let's see we cover up to under this policy.
[AGENT][NEUTRAL] We cover up to $8100 per calendar year and we go by what's on the primary insurance and according to the primary insurance, um, the payout amount which was $879.48 that's how much is owed.
[CUSTOMER][NEUTRAL] Let me look at that because we show a different balance.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So primary insurance puts $1,786.70 to patient responsibility for their deductible.
[AGENT][NEUTRAL] OK. One moment. I'm pulling the EOB also.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I see what happened. Yeah, they went by the wrong number. It looks like there may have been several mem, well, not several, but a couple of different members.
[AGENT][NEUTRAL] And um
[AGENT][NEUTRAL] Yeah, they went by the wrong one. So what I'll do is send this um back to be reprocessed and you can check on the status of it um within 7 to 10 business days.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, do you do a call reference number?
[AGENT][NEUTRAL] Yes, so the reference number, you can use my name and today's date. My name is [PII]. Um it's spelled [PII] Last initial is [PII] like [PII] and today's date. Um is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] No, that'll do it thank you very much for your help I appreciate it.
[AGENT][POSITIVE] OK, thank you, [PII] for calling APL. You have a great day. Mm bye.
[CUSTOMER][POSITIVE] You too thanks.
[AGENT][POSITIVE] Mhm. Thank