AccountId: 011433970860
ContactId: 5a6bc51d-bab7-439d-8e65-32c3313e0835
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 488410 ms
Total Talk Time (AGENT): 198699 ms
Total Talk Time (CUSTOMER): 176752 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/5a6bc51d-bab7-439d-8e65-32c3313e0835_20250108T15:23_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] Hi, I'm calling for claim status.
[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] [PII].
[AGENT][NEUTRAL] Thank you for that and lotto, may I have the member's policy number?
[CUSTOMER][NEUTRAL] 02284231.
[AGENT][NEUTRAL] Thank you and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Uh, it will be, let me see, it's 3 claims for the same patient.
[AGENT][NEUTRAL] OK, and can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Um, if you'd like, you can give me uh the dates of service and the total bill or we can do it one by one, whichever you prefer.
[CUSTOMER][NEUTRAL] OK, the first one is gonna be [PII] for 2150.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] OK, you wanna do them one by one?
[CUSTOMER][POSITIVE] Yeah, let's do one by one.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I don't know.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Good.
[CUSTOMER][NEUTRAL] The.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So 150, so this one.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Vital imaging diagnostic centers.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] So I'm showing we received the claim on [PII].
[CUSTOMER][NEUTRAL] Technically what we call the second um.
[AGENT][NEUTRAL] That claim number is 354.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 51997.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And on [PII], the claim was paid out on to the provider, a total of $105.37.
[CUSTOMER][NEUTRAL] You know
[CUSTOMER][NEUTRAL] Did it in a different place I mean it's like a different state, sorry.
[AGENT][NEUTRAL] And did you need that check information?
[CUSTOMER][NEUTRAL] Yeah please.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So it's a single check, um,
[AGENT][NEUTRAL] It was issued on [PII].
[AGENT][NEUTRAL] Check number 2020269.
[CUSTOMER][NEUTRAL] OK, is there a bulk amount for the check or just for that amount?
[AGENT][NEUTRAL] No, it's just for that amount.
[CUSTOMER][NEUTRAL] Just for 105 with 37.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and for the next one, OK, uh, let me see because the amount due for that one was 28689.
[CUSTOMER][NEUTRAL] So only 10537 was paid?
[AGENT][NEUTRAL] Right, hold on one moment. Let me hold on one second.
[CUSTOMER][NEUTRAL] Morning.
[AGENT][NEUTRAL] So that was all that they had left for their calendar year max, so it was applied to that to that claim, the rest of that balance.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, um, the difference would that be patient responsibility or or just have to be like voided or something?
[AGENT][NEUTRAL] Um, so that would be between primary and the provider because we're not the major medical, we don't determine patient responsibility.
[CUSTOMER][NEUTRAL] Oh, OK, OK, is there any way you could fax me, uh, the EOB like showing the payment or?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And should I put attention louder?
[CUSTOMER][POSITIVE] Yes please thank you.
[AGENT][NEUTRAL] OK, you're welcome, and that was [PII].
[CUSTOMER][NEUTRAL] Yes, if you want we can wait until uh we cover all claims so you can send me just one fax.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Well, it'll be 3s or have 3 separate claims, um, EOBs, but um I'm gonna send them at the end.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh OK, OK, perfect.
[AGENT][NEUTRAL] And you can go to the next number if you're ready.
[CUSTOMER][NEUTRAL] OK, it's gonna be the same. OK, uh, it's gonna be also [PII]. The bill amount is 1,275.
[AGENT][NEUTRAL] Or the next day the service.
[AGENT][NEUTRAL] 1,275.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, so for this claim, we received it on [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah
[AGENT][NEUTRAL] And that claim number is 354.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 5200.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] And on [PII].
[AGENT][NEUTRAL] Um, the claim was denied because the outpatient benefit for the calendar year has been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the next claim is for data service [PII].
[CUSTOMER][NEUTRAL] The amount is 1250.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So shall we received this claim on [PII]?
[AGENT][NEUTRAL] The claim number is 354.
[AGENT][NEUTRAL] 5195.
[AGENT][NEUTRAL] And on [PII], I'm sorry, 2024.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, we paid out on the claim to the provider a total of $94.63.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me get that checking information for you. Did you need the checking information for this one?
[CUSTOMER][NEUTRAL] Looking at the
[CUSTOMER][POSITIVE] Yes please.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] All right, well, uh, thank you, doctor. I will speak.
[AGENT][NEUTRAL] OK, so, um, it was a single check.
[CUSTOMER][NEUTRAL] Are you?
[AGENT][NEUTRAL] It was issued on [PII].
[AGENT][NEUTRAL] The check number is [PII].
[AGENT][NEUTRAL] 20.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK perfect and uh then if I could have the 3 EOBs faxed to me please.
[AGENT][NEUTRAL] Yes, and you said um that was [PII] attention [PII].
[CUSTOMER][POSITIVE] Yes, thank you so much.
[AGENT][NEUTRAL] All right, so I am sending them over to you now, so you should be receiving them um shortly, but I'll say in the day just in case because it's facts.
[CUSTOMER][POSITIVE] OK, OK, thank you so much you have a good day.
[AGENT][POSITIVE] You're welcome. You also, thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.