AccountId: 011433970860
ContactId: 5df69c6d-788c-47cc-9fed-c16ee89450b3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 400320 ms
Total Talk Time (AGENT): 176543 ms
Total Talk Time (CUSTOMER): 200983 ms
Interruptions: 4
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/5df69c6d-788c-47cc-9fed-c16ee89450b3_20250131T16:53_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] You know.
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from Proto's office to check on claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, [PII], and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] One client.
[AGENT][NEUTRAL] All right and may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Uh-huh. [PII] and my extension is gonna be [PII].
[AGENT][NEUTRAL] I'm sorry, the phone went in and out. Can you repeat that for me, please? I didn't hear the phone number, just the extension.
[CUSTOMER][NEUTRAL] [PII] and the extension is gonna be [PII].
[AGENT][NEUTRAL] Thank you for that and the member's policy number?
[CUSTOMER][NEUTRAL] 02455948
[AGENT][NEUTRAL] 02455948.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yup, the first name is [PII] and the last name is [PII] and date of birth, [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim you'd like me to check on?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yup, [PII].
[CUSTOMER][NEUTRAL] And the total bill amounts 125 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'm actually showing that there is no claim on file for [PII]. We actually have never processed a claim for her under her dental policy.
[CUSTOMER][NEUTRAL] So this is related to dental?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] The policy number that you gave was dental, Did you mean a medical policy?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, but we received EOB stating that the claim has been paid for $50. I do have a claim number for that.
[AGENT][NEUTRAL] OK, hold on one second because you gave the dental policy, so let me go to medical and then I can look up the data service.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so the medical policy number, uh, it's just a number of 245-5947. Um, so let me look under that policy. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, here we go.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright, and that's claim number 344-0524?
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, we made a payment of $50. Did you have questions on the claim?
[CUSTOMER][NEUTRAL] OK, so that
[CUSTOMER][NEUTRAL] Total bill amount is 125, right? So what is the allowed amount? So all allow amount and paid amount are the same, right?
[AGENT][NEUTRAL] Right, the benefit is $50 per visit with a max of 4 visits per calendar year, so the full $50 was applied.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] OK, so what is the provider write off amount on this claim?
[AGENT][NEUTRAL] We don't provide patient responsibility or write-off amount because we're not the major medical.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, it would, it would be whatever your procedures or policies are if there's an outstanding balance, but that would come from the provider.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEGATIVE] So the client paid for $50 right? with no patient responsibility.
[AGENT][NEUTRAL] We do not determine patient responsibility, but yes, we did apply $50 to the claim.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] It's applied to retable or.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] For the $50 paid to the provider or else it applies towards patient deductible.
[AGENT][NEUTRAL] No, the $50 was paid to the provider. Um, did you need the checking information?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Alright, so the check was issued on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Check number 18465997.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, so what is the claim receipt date and go on.
[AGENT][NEUTRAL] It was a single check in the amount of $50.
[AGENT][NEUTRAL] And it cleared on
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] What is the claim receipt date and the process date?
[AGENT][NEUTRAL] Did you need the rest of the checking information or you want me to go back to the claim?
[CUSTOMER][NEUTRAL] That's it. What sort of saving? Uh-huh.
[AGENT][NEUTRAL] OK, hold on one moment, let me go back to that.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The claim was received on [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And on [PII], the claim was processed?
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK, so what is the call reference number for this call?
[AGENT][NEUTRAL] Did you need the clear date or you just needed to know when it was issued?
[CUSTOMER][NEUTRAL] I don't have those information. So I just wanted to know, so there is an outstanding amount of $75.
[CUSTOMER][NEUTRAL] So it's applied towards provider write off or else if there is any denial on this claim because the total bill amount is 125.
[AGENT][NEUTRAL] There's
[AGENT][NEUTRAL] There's no denial. The max benefit is $50 so that's what was applied. Again, we don't determine patient responsibilities for, so for the remaining balance, you would have to see with your office how you all handle outstanding balances. Do you write it off, do you make it patient responsibility? We just can't tell you that because we're not major.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so what is the call reference number for this call?
[AGENT][NEUTRAL] There's no call reference number, but you can use my name, which is [PII] The first initial to my last name is [PII], and then today's date.
[CUSTOMER][POSITIVE] Yeah, thank you for your assist and patience. Have a nice day.
[AGENT][POSITIVE] You're welcome, [PII]. Thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] OK