AccountId: 011433970860
ContactId: 63aaa132-52a3-4ce5-a3c9-c0df24cfd6fb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 257220 ms
Total Talk Time (AGENT): 91290 ms
Total Talk Time (CUSTOMER): 76840 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/63aaa132-52a3-4ce5-a3c9-c0df24cfd6fb_20250205T15:29_UTC.wav
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[AGENT][POSITIVE] Good Morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, hey, this is [PII] and I'm calling from the office and I'm looking for for claim status.
[AGENT][NEUTRAL] Sure, I can assist you with claim status, Mr. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Um, sure, it's [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] So, uh,
[CUSTOMER][NEUTRAL] 01841211, M as in Mike, L as in Lima, number 7.
[AGENT][NEUTRAL] Mm OK. And what's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the date of service and the amount of the claims?
[CUSTOMER][NEUTRAL] And what is the date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Amount is $16,065.
[AGENT][NEUTRAL] OK. Let me see if I can find this claim for you and for future, you can check claim status online through our website at [PII] and that's just optional.
[CUSTOMER][NEUTRAL] All right. And meanwhile, can you please spell out your name?
[AGENT][NEUTRAL] Sure. That's [PII]. That is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And you said that you're welcome, the total charge was $16,065?
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK. One moment.
[AGENT][NEUTRAL] I'm waiting on the system, bear with me.
[CUSTOMER][POSITIVE] Mhm. Take your time.
[AGENT][NEUTRAL] OK, so it looks like we processed this claim back in [PII] and we send a benefit amount of $500 to the provider, which the $500 is the maximum per date of service.
[CUSTOMER][NEUTRAL] Uh, so is there any denial because we are still underpaid for this claim.
[AGENT][NEUTRAL] I'm sorry, can you repeat?
[CUSTOMER][NEUTRAL] Uh, can you please check if there any denial on this claim because we are underpaid for this claim.
[AGENT][NEUTRAL] Again, the maximum benefit on this policy is $500 per day.
[AGENT][NEUTRAL] So based on that benefit, we pay the maximum benefit, which it was $500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So what we need to do on this claim now?
[AGENT][NEUTRAL] It's up to the provider's discretion. We don't have any contractual involvement on the remaining of the claim.
[CUSTOMER][POSITIVE] Alright, thank you so much for helping me.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Can I have the reference number now?
[AGENT][NEUTRAL] G
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's state if you will. Do you need the spelling of my name or any other information?
[CUSTOMER][POSITIVE] Uh, no, that's all. Thank you so much. Have a good day.
[AGENT][POSITIVE] Mhm. You too. Thank you for calling ATO. Bye-bye, Mr. [PII].
[CUSTOMER][NEUTRAL] Bye bye.