AccountId: 011433970860
ContactId: 54d01273-66b4-466d-9330-75be47dece69
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 432570 ms
Total Talk Time (AGENT): 118035 ms
Total Talk Time (CUSTOMER): 141800 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/54d01273-66b4-466d-9330-75be47dece69_20250317T20:38_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APR. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi. This is [PII] calling regarding claim status.
[AGENT][NEUTRAL] Mm, sure, [PII], I can assist you with claim status. Um, first, I'll need a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII]. The [PII] is [PII].
[AGENT][NEUTRAL] OK, thank you. Now, I need the policy number, please.
[CUSTOMER][NEUTRAL] Yeah, sure. It is.
[CUSTOMER][NEUTRAL] Yeah, it's uh 60801.
[AGENT][NEUTRAL] No, that's our payer ID. I need the policy number.
[CUSTOMER][NEUTRAL] Yeah, sure. Uh, uh, shall we go through the member's name?
[AGENT][NEUTRAL] Do you have the social?
[CUSTOMER][NEUTRAL] Date of birth.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, I can use the name and date of birth. Um, what's the last name?
[CUSTOMER][NEUTRAL] Yeah, it's uh [PII]. It spells [PII].
[AGENT][NEUTRAL] My first name, please?
[CUSTOMER][NEUTRAL] Yeah, it's uh [PII]. It's spells [PII].
[AGENT][NEUTRAL] OK, thank you. I found her in our system. Would you like her policy number? Well, uh, first, what's her date of birth? I'm sorry.
[CUSTOMER][NEUTRAL] Oh yeah. It's uh [PII].
[AGENT][NEUTRAL] OK. Yes, sir. And I have her policy number here.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Oh yeah, sure. Please provide me.
[AGENT][NEUTRAL] Let me know when you're ready.
[CUSTOMER][POSITIVE] Yeah, I'm ready.
[AGENT][NEUTRAL] Policy number is 024.
[AGENT][NEUTRAL] 93492.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 492, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yeah, got it.
[AGENT][NEUTRAL] OK. And what's the date of service and bill charges on the claim?
[CUSTOMER][NEUTRAL] Yeah, it is [PII]. The total charges are
[CUSTOMER][NEUTRAL] Uh, after the primary processor, the left balance is $2000.00.
[AGENT][NEUTRAL] OK. Yes, sir. We received that claim on [PII].
[CUSTOMER][NEUTRAL] Yes, uh, I have a, a specific question. Actually, a claim got paid. So, but we are still underpaid. So we do not receive our expected amount. So is it possible to send back for review?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] No, sir, because under this policy, we cover up to $800 per day for outpatient services. So the benefit maximum was reached.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Yeah, is there any uh patient responsibility?
[AGENT][NEUTRAL] Um, yes, the remaining balance.
[CUSTOMER][NEUTRAL] Uh, uh, sorry. Could you please uh tell me the patient responsibility? What was the remaining?
[AGENT][NEUTRAL] 1200.
[CUSTOMER][NEUTRAL] Yeah, yeah, OK, fine. Uh, may I know why it is towards special responsibility?
[AGENT][NEUTRAL] We cover up to $800 per day for the charges that go towards the copay, the co-insurance, and the deductible.
[AGENT][NEUTRAL] So, the charges were $2000. We only covered $800 so the remaining is $1200.
[CUSTOMER][NEUTRAL] Uh, it is, uh, towards deductible. That's right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Yeah, is it, is it possible to request AOB?
[CUSTOMER][NEUTRAL] To the back.
[AGENT][NEUTRAL] Yes, I can. Yes, I can fax you the ELD. What's your fax number, please?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Yeah, uh, it is [PII].
[CUSTOMER][NEUTRAL] 578
[CUSTOMER][NEUTRAL] 2844. Attention to [PII].
[AGENT][NEUTRAL] OK, one moment, [PII]. Let me pull up my fax system.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, [PII], I just sent the EOB. Is there anything else that I can assist you with? You should receive it in about 10 minutes.
[CUSTOMER][NEUTRAL] 00 yeah. OK.
[CUSTOMER][NEUTRAL] Yeah. Could you please confirm the claim number?
[AGENT][NEUTRAL] The claim number is 356-9165.
[CUSTOMER][POSITIVE] Oh yeah, I got it.
[CUSTOMER][NEUTRAL] Yeah. Can I get the uh call reference number and your name?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date.
[AGENT][NEUTRAL] My name is [PII]. Um, it's spelled [PII] Last initial is [PII], and today's date. Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] No. And thank you so much for assisting today.
[AGENT][POSITIVE] OK. Well, I thank you again, [PII], for calling APL. You have a great rest of your day. Bye.
[CUSTOMER][NEUTRAL] Bye-bye.