AccountId: 011433970860
ContactId: 5b12b431-6a78-496e-a20f-7033e1ed42b1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 464369 ms
Total Talk Time (AGENT): 109469 ms
Total Talk Time (CUSTOMER): 90511 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/5b12b431-6a78-496e-a20f-7033e1ed42b1_20250408T12:49_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] calling from Was billing office looking for claim and EOB.
[AGENT][NEUTRAL] OK, [PII], you're wanting to check a claim status or do you already have the claim number?
[CUSTOMER][NEUTRAL] I do have a claim number here.
[AGENT][NEUTRAL] OK, [PII], I can help you with this. What is your callback number?
[CUSTOMER][NEUTRAL] It's [PII] that's a direct line.
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] Yes the policy you have here.
[CUSTOMER][NEUTRAL] 02498570
[AGENT][NEUTRAL] Thank you. One moment while I pull up the member's information, please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And any information [PII] that I provide would be a verification of benefits and not a guarantee of payment. What is your patient's name please and their date of birth?
[CUSTOMER][NEUTRAL] Yes, it's for [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount?
[CUSTOMER][NEUTRAL] Yep, [PII], it got billed for $406 even.
[AGENT][NEUTRAL] I'm so sorry. Would you please give me the bill amount again?
[CUSTOMER][NEUTRAL] Sure, no issues, $406406 and.
[AGENT][NEUTRAL] OK, thank you. Claim number?
[CUSTOMER][NEUTRAL] Yes, claim number I have here.
[CUSTOMER][NEUTRAL] 353-747-777
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] Give me just a moment, please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so now how can I help you on this claim?
[CUSTOMER][NEUTRAL] Mm, yes, we do have a claim but claim has got paid for $158.46 and um.
[CUSTOMER][NEUTRAL] I do have a check number 2016856 issued on [PII].
[CUSTOMER][NEUTRAL] Uh, we have requested for an EOB and it was requested on [PII], and we haven't received an EOB. Is that possible to mail or fax me an EOB.
[AGENT][NEUTRAL] OK, so as I, uh, I can see this on file, [PII], now because this.
[AGENT][NEUTRAL] This benefit, um, no, no, sir, there's not an EOB for this. This was paid to the member. This benefit was paid to the member, so there would not be an EOB.
[CUSTOMER][NEUTRAL] And uh is that uh paid under same details you have provided?
[AGENT][NEUTRAL] Um, it is.
[AGENT][NEUTRAL] Let me look at one thing. Let me double check this claim number you gave me because.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Uh yes, sir. So that is actually more information than you should have actually acquired from us, seeing how this benefit was paid directly to the member. So you would have to reach out to the member for any additional information.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure, just give me a moment.
[CUSTOMER][NEUTRAL] Just give me a moment.
[AGENT][NEUTRAL] Sure, yes, sir. Uh-huh.
[CUSTOMER][NEUTRAL] Just give me a moment please, [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Is the entire amount paid or uh any patient responsibility in that?
[AGENT][NEUTRAL] Uh, we do not determine patient responsibility because this is a supplemental time that would always be up to the provider.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm so.
[CUSTOMER][NEUTRAL] I know why was the claim paid to patient, uh, so is that a supplement policy that the reason?
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] We do not have a claim on file from the provider.
[CUSTOMER][NEUTRAL] Sure, you have me call references.
[AGENT][NEUTRAL] Uh yes, sir, you would use my name along with today's date.
[CUSTOMER][POSITIVE] Thank you, [PII]. Thanks for assisting. Take care. So for the day.
[AGENT][POSITIVE] Well, you're certainly welcome, yes. So if that is all that I can help you with, uh, thank you again for calling APL Tom and I hope you have a very nice day.
[CUSTOMER][POSITIVE] Take care. Bye now.
[AGENT][POSITIVE] Oh, thank you. You too. Bye-bye.
[CUSTOMER][NEUTRAL] Mm