AccountId: 011433970860
ContactId: 6e6e8818-d784-400b-bbad-57d31924088d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 172110 ms
Total Talk Time (AGENT): 66461 ms
Total Talk Time (CUSTOMER): 87681 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/6e6e8818-d784-400b-bbad-57d31924088d_20250117T21:16_UTC.wav
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[AGENT][NEUTRAL] This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] on the care team. How are you?
[AGENT][POSITIVE] I'm good. How are you?
[CUSTOMER][NEUTRAL] I'm OK. I just have a provider on the other line that's asking a lot of questions about this explanation of benefits. Can you look at this for me? I just wanna know if, if I'm explaining this correctly.
[AGENT][NEUTRAL] OK, do you have the claim number?
[CUSTOMER][NEUTRAL] Mhm. It is, oh wait, that's the policy number, um 353-571-9.
[AGENT][NEUTRAL] What's the name?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The patient is [PII].
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] I was just wondering if it was a lady I talked to this morning.
[AGENT][NEUTRAL] Oh, this is on a dental?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and what are they asking?
[CUSTOMER][NEUTRAL] So, on the explanation of benefits, she's asking this patient responsibility uh column.
[CUSTOMER][NEUTRAL] If this is saying this is what the patient owes, or was that what the, that was just the patient's responsibility of the 60?
[CUSTOMER][NEUTRAL] But we paid everything that was scheduled.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah, we don't cover the uh [PII] procedure.
[AGENT][NEUTRAL] So he, she's responsible of 50. Why I got 58, let's see, hold on, OK, because they charged 60.
[AGENT][NEUTRAL] You only pay 56. Yeah, patient owes 58, so that would be what the patient would owe them.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, cause she's saying, OK, wait a minute.
[CUSTOMER][NEUTRAL] So the 4, so the patient responsibility column is what is owed, is what the patient owes, the $58.
[AGENT][NEUTRAL] Right, uh-huh.
[CUSTOMER][NEUTRAL] OK, so she, she asked me if it was scheduled at 56 and it covered at 100 and we paid 56. The 4 is the difference between the 56 and the 60.
[AGENT][NEUTRAL] I don't know what she talking about.
[CUSTOMER][NEUTRAL] And the 7 because I thought I said the the $4 is the difference because it was charged $60 and we paid $56 which is what was scheduled, right?
[AGENT][NEUTRAL] Yeah, just go line by line with her, say the 1206 you charge $50 we don't cover it at all, so that's her $50.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The 272 is 60.
[AGENT][NEUTRAL] The schedule of benefits is 56.
[AGENT][NEUTRAL] So she would owe that $4.
[CUSTOMER][NEUTRAL] Oh, the schedule of benefits is what we'll pay for that. OK, I got it. OK.
[AGENT][NEUTRAL] Well, we pay, right, and then the 80, we in the schedule 76 and we paid 76, so she's responsible for 58.
[CUSTOMER][POSITIVE] Do, OK, I got it. Thank you.
[AGENT][NEUTRAL] Mhm. OK. You're welcome.
[CUSTOMER][NEUTRAL] All right, bye bye.
[AGENT][NEUTRAL] Bye bye.