AccountId: 011433970860
ContactId: 5cac84e5-e0ec-4bb4-949d-29c730376398
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 208179 ms
Total Talk Time (AGENT): 90414 ms
Total Talk Time (CUSTOMER): 55927 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/5cac84e5-e0ec-4bb4-949d-29c730376398_20250224T17:46_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, this is [PII] calling from the provider's office to check on a claim status.
[AGENT][POSITIVE] [PII], it would be my pleasure to assist you. What is the callback number?
[CUSTOMER][NEUTRAL] Call that number.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you. And [PII], what is the policy number for the patient, please?
[CUSTOMER][NEUTRAL] Repeat that.
[AGENT][NEUTRAL] The policy number?
[CUSTOMER][NEUTRAL] Yeah, it is D as in Delta 46701275.
[AGENT][NEUTRAL] Now our policy does not start with the letter, it starts with a 0. Do you have an all numerical policy number for the patient?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] Yeah, it is 021-79701.
[AGENT][NEUTRAL] And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] OK. The patient name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] All right, thank you, and I can help you with that eligibility and claim status.
[AGENT][NEUTRAL] And [PII], I'm showing that the policy was active from [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And turned on [PII].
[AGENT][NEUTRAL] And you were needing claim status as well?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] What was the date of service?
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] [PII] and the total bill amount is $282 even.
[AGENT][NEUTRAL] And what is the facility name?
[CUSTOMER][NEUTRAL] Now want help, Go Health urgent care.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] I can help you with that claim information. Now [PII], we received that claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And we paid the maximum benefit payable for that data service of $50 to the provider.
[CUSTOMER][NEUTRAL] How much?
[AGENT][NEUTRAL] $50.
[CUSTOMER][NEUTRAL] 50.
[AGENT][NEUTRAL] Yes ma'am, and that is the maximum benefit payable for that data service.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh why?
[AGENT][NEUTRAL] Would you like
[CUSTOMER][NEUTRAL] May I know the reason why it has been paid less?
[AGENT][NEUTRAL] That this is a limited indemnity policy and the maximum benefit payable for that data service is $50 and that's for the patient's policy.
[CUSTOMER][NEUTRAL] What about the remaining amount?
[AGENT][NEUTRAL] That would be determined by the provider if you bill the patient or what is the patient responsibility.