AccountId: 011433970860
ContactId: 5d533e06-cff9-466c-b3cd-d1e63a2cc9d5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 477679 ms
Total Talk Time (AGENT): 193925 ms
Total Talk Time (CUSTOMER): 133729 ms
Interruptions: 1
Overall Sentiment: AGENT=1.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/5d533e06-cff9-466c-b3cd-d1e63a2cc9d5_20250210T13:52_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is calling from provider's office to checking up on claim status.
[AGENT][NEUTRAL] OK, I'm so sorry, what was your name?
[CUSTOMER][NEUTRAL] Yeah, it is like [PII].
[AGENT][NEUTRAL] OK, [PII] and your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and you said that you were needing claim status like, is that correct?
[CUSTOMER][NEUTRAL] Yes, checking up on claim status.
[AGENT][NEUTRAL] Yes, I can help you with that. And how many points do you have to check status on?
[CUSTOMER][NEUTRAL] Yeah, it is only one.
[AGENT][NEUTRAL] OK, I can help you. What is the member's policy number?
[CUSTOMER][NEUTRAL] 02287960.
[CUSTOMER][NEUTRAL] M for Mike, L for Lima, 7.
[AGENT][POSITIVE] OK, thank you one moment please.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And like any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, patient's name is uh [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the date of birth was uh [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, you like, what is the date of service and total bill amount for him, please?
[CUSTOMER][NEUTRAL] Yeah, sure. It is uh.
[CUSTOMER][NEUTRAL] [PII], uh, with the bill amount of uh $1803 even.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm so sorry. Can you please give me the amount again?
[CUSTOMER][NEUTRAL] Yeah. The date of service was [PII] and the total charge amount is uh $1,803 even.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 1803. Is that correct?
[CUSTOMER][POSITIVE] Yes, perfect.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so like this claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3557461.
[AGENT][NEUTRAL] There was a benefit paid in the amount of $75.
[AGENT][NEUTRAL] And that was paid on single check 202-5012.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] And that is still showing as outstanding at this.
[AGENT][NEUTRAL] Time
[AGENT][NEUTRAL] And the other, that was the $75 benefit was paid on code.
[AGENT][NEUTRAL] 644483.
[AGENT][NEUTRAL] And the other codes were denied with the remark insured major medical.
[AGENT][NEUTRAL] Coverage provided full benefits, no benefits payable for this procedure.
[CUSTOMER][NEUTRAL] OK. Uh, it was received on [PII], right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And it was processed on [PII]?
[AGENT][NEUTRAL] Let me go back to that screen again.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Yeah, and the uh claim number is 3557461, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Uh, wait, what is the allowed amount and trade amount? It is $75 even.
[AGENT][NEUTRAL] This is a supplemental policy that only helps with co-pays, deductibles, and co-insurance amounts of covered services.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So the $75 was the benefit paid. There were no other benefits payable on this claim.
[CUSTOMER][NEUTRAL] Yeah, uh.
[AGENT][NEUTRAL] The insured's primary insurance paid in full.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yeah. Uh, the amount is $75 right?
[AGENT][NEUTRAL] The $75.
[CUSTOMER][NEUTRAL] It's a paid amount, right?
[AGENT][NEUTRAL] was
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. And there is no patient responsibility or anything?
[AGENT][NEUTRAL] We do not determine patient responsibility.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That would be up to the provider and if you need a copy of this explanation of benefits because the check hasn't had time to get there, you can print it from our portal and like the website to go to to print the EOB would be secured.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, it is paid through check, right?
[AGENT][NEUTRAL] Yes, sir, and I gave you the check number, single check.
[CUSTOMER][NEUTRAL] 2202-5012, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] Uh, thank you so much for the information and uh
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][NEUTRAL] Uh, uh, may I have the check mailing address?
[AGENT][NEUTRAL] Go ahead and verify what was on the claim.
[CUSTOMER][NEUTRAL] Yeah, it is uh [PII]. Sorry, sorry, sorry, sorry for that. Yeah, it is a [PII].
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] No, sir, that's our, no, sir, that's.
[AGENT][NEUTRAL] And that's, and you need to update. Uh-huh, go ahead.
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Uh, is a check cash?
[AGENT][POSITIVE] It is, as I stated, it is still outstanding.
[CUSTOMER][NEUTRAL] OK. Uh, what is the pay date?
[AGENT][NEUTRAL] The same date as the process date?
[CUSTOMER][NEUTRAL] Of [PII], right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you so much for the information. And uh uh may I know your name, please?
[AGENT][NEUTRAL] Again, my name is [PII] and you will use my name and today's date as your call reference number like T R A C I T R A C I.
[CUSTOMER][NEUTRAL] Uh, could you
[CUSTOMER][NEUTRAL] Could you please spell your name?
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're very welcome. And is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] Thank you. Thank you so much for the information. Thank you for asking me.
[AGENT][POSITIVE] OK, well have a great day and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Yeah, bye bye.
[AGENT][NEUTRAL] Uh-huh. Bye-bye.
[CUSTOMER][NEUTRAL] Mm