AccountId: 011433970860
ContactId: 561689e9-6566-47ef-a59b-0dee663b5197
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 421559 ms
Total Talk Time (AGENT): 116292 ms
Total Talk Time (CUSTOMER): 99624 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/561689e9-6566-47ef-a59b-0dee663b5197_20250502T20:53_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from provider Of Surgery Center at [PII].
[AGENT][NEUTRAL] OK, I'm sorry, [PII], how may I assist you today?
[CUSTOMER][NEUTRAL] Uh, to check the claim status.
[AGENT][NEUTRAL] OK, I'll verify claim status for you. And what is that policy number, please?
[CUSTOMER][NEUTRAL] Uh, one moment, please. I'm just providing it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, the member ID is 016553.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you. Give me one moment please.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Uh, the callback number is [PII].
[AGENT][POSITIVE] OK, thank you. Give me one moment, please.
[CUSTOMER][NEUTRAL] Could you please spell out your name for me?
[AGENT][NEUTRAL] Sure. [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Patient name is uh [PII] and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] Uh, the date of service is on [PII] and the charge amount is, uh,
[CUSTOMER][NEUTRAL] $3,708.90.
[AGENT][NEUTRAL] And the balance after primary?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The balance amount is uh
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And you said the date of service was [PII]?
[CUSTOMER][NEUTRAL] Uh, 17
[CUSTOMER][NEUTRAL] $1730.38.
[AGENT][NEUTRAL] And you said the date of service was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hey, I don't show we received a claim for that data service. Can you verify the mailing address it was submitted to you?
[CUSTOMER][NEUTRAL] Uh, we have the OB. Can you check with the
[AGENT][NEUTRAL] What's the claim number?
[CUSTOMER][NEUTRAL] Claim number would be 3393607.
[AGENT][NEUTRAL] Uh, that claim was not for [PII] as I verified. Can you verify the mailing address or mailing address, the data service and make sure we have it correct?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I'm just checking that information.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh, the mailing address that we have submitted is uh [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, but no, sir. I, what was uh verify the date of service again because I verified with you twice at [PII]. So I want to make sure I get it correct. What was the correct date of service?
[CUSTOMER][POSITIVE] Uh, so sorry for that.
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, on that claim, I show that we paid 52455.
[CUSTOMER][NEUTRAL] OK, also we have uh receiving that EOP member has a deductible of uh
[CUSTOMER][NEUTRAL] 900, uh.
[CUSTOMER][NEUTRAL] Uh, $975.45 of deductible amount. What is the total deductible amount for the member?
[AGENT][NEUTRAL] Alright see.
[AGENT][NEUTRAL] For outpatient, give me a moment.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] Uh, looks like the patient has an outpatient benefit, uh, or outpatient deductible of $1500 per calendar year.
[CUSTOMER][NEUTRAL] Uh, how much the patient was met?
[AGENT][NEUTRAL] Well, it doesn't matter because this claim, it processes benefits, uh, some benefits were applied towards the deductible, so they had not met their deductible of [PII] at the time of this claim being received and processed.
[CUSTOMER][POSITIVE] OK, thank you so much, uh.
[CUSTOMER][NEUTRAL] Can I have the call reference number?
[AGENT][NEUTRAL] Uh, we don't give reference numbers. If you like, you may use my name at today's date, and is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Nothing else needed. Uh, thank you so much.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a great day, [PII].