AccountId: 011433970860
ContactId: 58c3483b-f17a-46dd-8f18-ceac78ef4905
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 261899 ms
Total Talk Time (AGENT): 117279 ms
Total Talk Time (CUSTOMER): 104720 ms
Interruptions: 0
Overall Sentiment: AGENT=2.2, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/58c3483b-f17a-46dd-8f18-ceac78ef4905_20250306T17:29_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good afternoon. This is [PII] calling from provider service to check on the claims. How are you doing today?
[AGENT][POSITIVE] I'm doing well, [PII]. Thank you for asking. How are you today?
[CUSTOMER][POSITIVE] It's fine. I'm doing great. Thank you so much for asking. Sorry, I did not catch your name. If you don't mind, may I know your name, please?
[AGENT][NEUTRAL] It would be my pleasure, [PII]. My name is [PII], that's [PII].
[AGENT][NEUTRAL] And [PII], could I get a good, could I get a good callback number in case we get disconnected?
[CUSTOMER][POSITIVE] [PII]. Thank you so much.
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[CUSTOMER][NEUTRAL] [PII] and it's a direct line?
[AGENT][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] And I understand you're needing is are you needing claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, I can help you with that. And what is the policy number?
[CUSTOMER][NEUTRAL] Sure. Policy number is going to be 09, sorry, it is going to be 01936591 M as in Mike, L as in Lima, number 7.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] This is uh [PII]'s date of birth is [PII].
[AGENT][POSITIVE] Alright, thank you, it would be my pleasure to help you with that claim status. Do you have a data service or a claim number?
[CUSTOMER][NEUTRAL] Uh, just give me one moment. Let me provide you the claim number.
[CUSTOMER][NEUTRAL] Yes, and the claim number is going to be
[CUSTOMER][NEUTRAL] 355
[CUSTOMER][NEUTRAL] 2974.
[AGENT][NEUTRAL] Thank you. And do you mind verifying the date of service and facility name?
[CUSTOMER][NEUTRAL] Yes, the date of service is [PII]. That is for the total charge amount of $3,291. And I'm calling from Kendall Anastasia Associates.
[AGENT][POSITIVE] All right, perfect.
[AGENT][NEUTRAL] And I'm sorry, what was that bill amount?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 3291.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] [PII], I am showing that we received that claim on [PII].
[AGENT][NEUTRAL] The claim was processed and paid.
[AGENT][NEUTRAL] In the amount of $5744 to Kindle Anesthesia Associates.
[CUSTOMER][NEUTRAL] Uh, yes, sir. Actually, I do have a particular question. Sorry for the interrupting you. Uh, when I check the primary, uh the total the, uh, patient responsibility, uh, the total leftover balance from the primary is going to be $884 even. Uh, but we received a payment only for the $574 and still we need to receive a payment of $310. May I know why we received the last payment?
[AGENT][POSITIVE] Not a problem.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Absolutely. So when we received that claim, the inpatient hospital benefit is a calendar year benefit.
[AGENT][NEUTRAL] When we received your claim, we only had a remaining benefit amount of $574 which was paid. With that payment of that check, it maxed out the inpatient hospital benefit for the calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] And uh do we need to build this $310 for the patient?
[AGENT][NEUTRAL] So, APL is the secondary to their major medical or not major medical and don't determine patient responsibility.
[CUSTOMER][POSITIVE] Yeah, OK, thank you so much. Uh, can I get the call reference number, [PII]?
[AGENT][POSITIVE] Oh, it's going to be my name in today's date, and it has been a pleasure to assist you with that claim status. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] Uh, no, this, I don't have anything much for today. Thank you so much. Have a wonderful day. Bye. OK.
[AGENT][POSITIVE] And thank you for calling APL. Hope you have a wonderful day, [PII]. Thank you.