AccountId: 011433970860
ContactId: 653337d5-ca57-4f17-aa95-6689f3125f58
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 532479 ms
Total Talk Time (AGENT): 185366 ms
Total Talk Time (CUSTOMER): 168052 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/653337d5-ca57-4f17-aa95-6689f3125f58_20250505T14:01_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII], uh, calling from Asan to looking for a claim status.
[AGENT][NEUTRAL] OK, I can check on a claim for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Can you hear me? Hello?
[AGENT][NEUTRAL] Yes, can you hear me?
[CUSTOMER][NEUTRAL] Yes, now I can hear you.
[AGENT][NEUTRAL] OK, can I get a good call back number from you, [PII], in case we're disconnected?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, it's uh just a minute.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It's [PII] and this is the direct line.
[AGENT][NEUTRAL] OK, thank you and then do you have that policy number?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] The policy number, please?
[CUSTOMER][NEUTRAL] Yes, uh it's going to be.
[CUSTOMER][NEUTRAL] 02487761
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] It's [PII] on the date of birth of [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that and what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Uh, the date of service is [PII], it's 5-28-2024.
[AGENT][NEUTRAL] 528 of 24.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and then do you have that uh bill amount?
[CUSTOMER][NEUTRAL] Uh, yeah, the bill amount is going to be.
[CUSTOMER][NEUTRAL] $1,409 even?
[AGENT][NEUTRAL] OK thank you one moment please.
[CUSTOMER][NEUTRAL] Mm mhm.
[AGENT][NEUTRAL] What was the name of this provider [PII]?
[CUSTOMER][NEUTRAL] Yes, the provider's name is going to be.
[CUSTOMER][NEUTRAL] It's uh [PII]
[AGENT][NEUTRAL] Um, do you have that tax ID by chance?
[CUSTOMER][NEUTRAL] Uh yes, the tax ID number is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] OK, yes, I apologize for the wait. Uh, it looks like we received this claim multiple times, so I did have to find the original um.
[AGENT][NEUTRAL] Let's see, so I did.
[CUSTOMER][NEUTRAL] Yes. OK, OK, OK. I need the original status only. Mhm.
[AGENT][NEUTRAL] Sure, yes, so I did find the original, uh, we paid a benefit of $500 and that did meet their, uh, total benefit maximum.
[CUSTOMER][NEUTRAL] Oh, when did you receive this claim and process the claim?
[AGENT][NEUTRAL] Sure, one moment, let me get that for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, this claim was received [PII].
[AGENT][NEUTRAL] And it was processed [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I know the claim number?
[AGENT][NEUTRAL] That is 347-9949.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 3479949, I'm right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, what is the claim allowed amount?
[AGENT][NEUTRAL] The total benefit amount for this policy is $500 per calendar year and that is the total amount we paid for this claim.
[CUSTOMER][NEUTRAL] Uh, the allowed amount is $500 the paid amount also is the same $500 right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] And it's paid through EFDR paper check.
[AGENT][NEUTRAL] Uh, it was a paper check.
[CUSTOMER][NEUTRAL] When I check number?
[AGENT][NEUTRAL] Yes, that is 1,862,160.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, OK. And it's a bulk check or a single?
[AGENT][NEUTRAL] Yeah the single check.
[CUSTOMER][NEUTRAL] Yeah, OK. And it's, may I know the issue date and the cash date of this check?
[AGENT][NEUTRAL] Yes, uh, this was issued [PII], and it did clear [PII] excuse me, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, it's [PII] itself the.
[CUSTOMER][NEUTRAL] It has been cash down right to the provider?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh yes. Uh, just a minute. Uh, upon checking, you say the client paid amount is 500. Uh, in this claim, we have 5 CDD codes, 5 line items for 2393 of number 45, 12, 130, 19. These all the codes are paid that anyone denied?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] No, um, so we paid on 3, we didn't pay on, let's see.
[AGENT][NEUTRAL] 2392 uh there were 2 uh 42 I think.
[AGENT][NEUTRAL] 19 and 5, I believe.
[AGENT][NEUTRAL] Yes, uh, those are the two we did not pay on simply because there was nothing left after that, uh, $500.
[CUSTOMER][NEUTRAL] 2392 2392 is.
[AGENT][NEUTRAL] If you need [PII], I can.
[AGENT][NEUTRAL] Uh, for 219 and 25, um, I can send you the uh copy of this EOB if you need that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh yes. Uh, C 23922 number 45119 is denied.
[AGENT][NEUTRAL] Sure, do you have a fax number?
[AGENT][NEUTRAL] He's 5 and 19, yes, as there was no more um benefit amount to pay.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] No more benefits I, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah, OK, and.
[CUSTOMER][NEUTRAL] The fax number is going to be.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 315
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 362
[CUSTOMER][NEUTRAL] 3826 and it's attention to this number of 203.
[CUSTOMER][NEUTRAL] 167385
[AGENT][NEUTRAL] OK, I'm gonna read that uh fax number back to make sure I heard that correctly. That was [PII].
[CUSTOMER][POSITIVE] Yes, you are right.
[AGENT][NEUTRAL] OK, and attention to [PII].
[CUSTOMER][POSITIVE] Yes, you're right.
[AGENT][POSITIVE] OK, I will go ahead and get that sent now. I should get it within about 10 minutes or so. Was there anything else I could help you with?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, OK, uh, could you spell your name for me?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] Yeah, I got it, [PII]. Thank you. And may I know the reference call reference number for this call?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial and today's date and so my last initial is A as in alpha.
[CUSTOMER][POSITIVE] Yeah, [PII], thank you so much for wonderful assist uh. I don't my clients. Have a nice day.
[AGENT][POSITIVE] Of course, yeah, thanks for giving us a call [PII] have a great rest of your day.
[CUSTOMER][NEUTRAL] Yeah, uh, you send this for uh the custody will be OK.
[AGENT][POSITIVE] Yes, yes, it's I'm sending it right now.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][POSITIVE] All right thank you have a great rest of your day.
[CUSTOMER][NEUTRAL] Yeah, you too. Bye-bye.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Mhm.