AccountId: 011433970860
ContactId: 4e68e98b-d583-4133-8521-d7f8b960a7cd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 393859 ms
Total Talk Time (AGENT): 174504 ms
Total Talk Time (CUSTOMER): 116440 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/4e68e98b-d583-4133-8521-d7f8b960a7cd_20250306T19:45_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, yes, I'm calling to check on the status of a claim.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] and it's [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Um, that is 607-703.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Born with [PII] and it's [PII]. I'm sorry, [PII].
[AGENT][POSITIVE] Thank you for that.
[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 for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Um, it's all the way back from [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Looks like 490.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the um facility on the claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] So, I'm showing the policy, the claim, I'm sorry, was received on [PII].
[AGENT][NEUTRAL] The claim number is 349-8967.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim to the provider, a total of $314.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and how was that payment made?
[AGENT][NEUTRAL] Um, it was made with a check. Let me get that check information for you. Hold on one moment.
[AGENT][NEUTRAL] So it was a single check, um, check number is 1870467. It was in the amount of $314. It was issued on [PII].
[AGENT][NEUTRAL] Uh, and it was, it cleared on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, and just the general questions about the claims just because I did just get one of his EOBs, um, in the mail from December, um, I have that the payments that are made, um, like for his December claim APL paid 128.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, is there any difference that we're supposed to put in for the patient as far as the contracted amount, um, on his claims?
[AGENT][NEUTRAL] Um, no, so the, so we just, we just pay towards the claim based on the benefits of their policy. So if there is an outstanding balance, um, it would just be whatever your, um, as a provider, whatever the next steps would be billing or writing off, but we can't determine that because we're not a major medical.
[CUSTOMER][NEUTRAL] OK, alright, because I just see on his EOB from December under provider.
[AGENT][NEUTRAL] Oh, well, you know what?
[AGENT][NEUTRAL] Hold on, I'm sorry. This is a dental claim.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] I believe the EOB is on the
[CUSTOMER][NEUTRAL] I thought I remember hearing that.
[AGENT][NEUTRAL] Hold on, I believe the patient responsibility is on the ELB. I'm pulling it up now. Hold on one second.
[AGENT][NEUTRAL] 67.
[CUSTOMER][NEUTRAL] And when you get a second, can I have that EOB sent to me by chance?
[AGENT][NEUTRAL] Sure, I can fax it to you. Um, what is this data service? Hold on one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Process 828.
[CUSTOMER][NEUTRAL] Uh oh.
[AGENT][NEUTRAL] It's coming up now.
[CUSTOMER][NEUTRAL] Sorry, I'm on the phone.
[AGENT][NEUTRAL] OK, so the patient responsibility.
[AGENT][NEUTRAL] For each was $88.
[CUSTOMER][NEUTRAL] OK, so that's for um [PII]?
[AGENT][NEUTRAL] Yes, for 23, and 4.
[CUSTOMER][NEUTRAL] $2488.
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] 3 and 4 patient portion.
[CUSTOMER][NEUTRAL] Um, OK, so he should owe 176, OK, um.
[CUSTOMER][POSITIVE] All right, thank you very much um.
[AGENT][POSITIVE] You're very welcome and I'm faxing this over to you now. I'm waiting for it to come up. Um, oh, it just popped up. So I'm getting ready to fax this over to you now. You should be receiving it um shortly. If you don't receive it by the end of day today, just give us a call back and we'll be more than happy to resend it for you, but I am sending it to you now.
[CUSTOMER][POSITIVE] OK all right thank you.
[AGENT][NEUTRAL] You're welcome. Actually, hold on.
[AGENT][NEUTRAL] This is the regular number. What is the fax number? I'm sorry, we didn't give the fax number.
[CUSTOMER][NEUTRAL] Um, it's 504.
[CUSTOMER][NEUTRAL] 737.
[CUSTOMER][NEUTRAL] 354 7
[AGENT][NEUTRAL] OK. [PII] attention [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Alright, and I just sent it over to you. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] Um, no, that's it, thank you.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] Alright thank you you too bye.