AccountId: 011433970860
ContactId: 68e32e89-8262-4d38-a2f6-739f68e17e03
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 284209 ms
Total Talk Time (AGENT): 122038 ms
Total Talk Time (CUSTOMER): 65376 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/68e32e89-8262-4d38-a2f6-739f68e17e03_20250414T18:36_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I just need some clarification on a claim and how it processed.
[AGENT][NEUTRAL] OK, you're needing to check claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes, I have the claim in front of me. I just need to know the um details like the processing is there any patient responsibility, I guess.
[AGENT][NEUTRAL] OK. Yes, ma'am. I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] D as in Delta, 40409055.
[AGENT][NEUTRAL] OK, now, thank you, but [PII], that's an APL policy number, that is a 90 degree benefit number. Were you trying to reach 90 degree benefits? Or is your explanation of benefits from APL?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] It's from APL like try this member ID. I'll give you the one that showed up on the um EOB.
[CUSTOMER][NEUTRAL] 02597826
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, yes, ma'am. That's the one that I need for APL. So one moment, please.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Any information that I do provide for you today will be a and not a guarantee of payment.
[CUSTOMER][NEUTRAL] Are you there?
[AGENT][NEUTRAL] Yes, ma'am, can you hear me?
[CUSTOMER][POSITIVE] Yep I can now.
[AGENT][NEUTRAL] OK, I don't know. There's, uh, something wrong with the phone line, I believe, but I'm sorry about that. So again, any information that I provide for you will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount?
[CUSTOMER][NEUTRAL] [PII] $350.50.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 350.50.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and you already said, is that correct?
[CUSTOMER][NEUTRAL] Say that again I'm sorry.
[AGENT][NEUTRAL] Do you have the claim number for this data service?
[CUSTOMER][NEUTRAL] Yes, I do have the claim number, yeah, it's 3582375.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes ma'am, that is correct. OK, and I do show that there was a $50 benefit issued on this claim.
[AGENT][NEUTRAL] And with this check, the maximum benefit payable service has been met.
[AGENT][NEUTRAL] Now, this is not major medical insurance. We
[AGENT][NEUTRAL] Do not determine patient responsibility, that would be.
[CUSTOMER][NEUTRAL] OK, so you guys don't determine patient responsibility, OK.
[AGENT][NEUTRAL] This is a limited
[AGENT][NEUTRAL] Benefit plan that he has with they.
[AGENT][NEUTRAL] No, ma'am, I don't.
[CUSTOMER][NEUTRAL] Alright, just need a reference number, [PII] and I'll be good to go.
[AGENT][NEUTRAL] Now,
[AGENT][NEUTRAL] Sure you're gonna use my name along with today's date, but I did wanna give you one additional piece of information. We have a portal that you should also be able to check claim status in just for future reference, um, by going to [PII]. But if for any reason you're not able to access the information you're looking for then obviously always give us a call.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] All right. Thank you, [PII]. You have a good rest of your day.
[AGENT][NEUTRAL] Well