AccountId: 011433970860
ContactId: 70484f82-37ad-465a-8896-ce0e55aac43a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 327640 ms
Total Talk Time (AGENT): 133238 ms
Total Talk Time (CUSTOMER): 149753 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/70484f82-37ad-465a-8896-ce0e55aac43a_20250311T15:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, I'm sorry you cut out. What was your name again? I apologize.
[AGENT][NEUTRAL] No, that's OK. It's [PII]
[CUSTOMER][NEUTRAL] Got you. You just cut out. I couldn't hear you.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, my name is [PII] I'm a provider rep.
[AGENT][NEUTRAL] OK, what can we help you with?
[CUSTOMER][NEUTRAL] Uh, I'm checking to see why this claim.
[CUSTOMER][NEUTRAL] Looks like it's denied. Hang on, let me double check.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, you guys only pay $500 so I'm checking to see why because I got a balance of 1414.80. So let's look at this one.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, yeah, I can get clarification for that claim. Um, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII], secure line.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Directly to me.
[AGENT][POSITIVE] Perfect, thanks for that. um, do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, well, I have the patient's ID number 01656930.
[AGENT][NEUTRAL] OK and uh what was the name and date of birth for the insured please?
[CUSTOMER][NEUTRAL] Uh, [PII], [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that [PII] um do you have that claim number?
[CUSTOMER][NEUTRAL] Let me see, hang on.
[CUSTOMER][NEUTRAL] Well, the claim number, it's just weird, uh.
[CUSTOMER][NEUTRAL] The claim number is 3,568,080.
[AGENT][POSITIVE] OK awesome thank you for that one moment let me get that pulled up.
[CUSTOMER][NEUTRAL] Yeah, because I'm looking at something on here.
[CUSTOMER][NEUTRAL] Because we didn't bill.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEGATIVE] Yeah, that's not right, unless.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't know what you guys did. Well, we bill 4376.20.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so the $500 that we did pay, that was the maximum benefit amount payable so as this is their secondary medical policy, the outpatient benefit, um, it pays on a per calendar day basis, so it pays up to a maximum of $500 per calendar day.
[CUSTOMER][MIXED] OK, but why does it not show what we build is what I'm confused.
[AGENT][NEUTRAL] Um, let me get that EOB pulled up. Give me just a moment.
[CUSTOMER][NEUTRAL] Because it only shows uh $500. I'm sorry, I didn't mean to over talk you I apologize. Uh, it only shows we billed $500.
[AGENT][NEUTRAL] No, no, that's fine.
[AGENT][NEUTRAL] OK, um, that, well, let's see.
[CUSTOMER][NEUTRAL] See it should show build amount.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, let me see because I'm showing that the bill amount we received was uh $1,914.81. Is that correct?
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] No, it's not.
[CUSTOMER][NEUTRAL] Alright, let me look down here 10 the 2 on this one.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Oh, wait a minute now, hang on. Total bill charges of $4,376.20.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Is that right? OK, let me send you this, uh, EOB that does show that information. So, um, at the top it does say total bills charges and then of course the amount we paid which was the $500. So, um, did you want, do you have a fax number I could send this to you?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, I'm ready when you are.
[CUSTOMER][NEUTRAL] Hang on, I'm just uh
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Uh correct yeah be with.
[CUSTOMER][NEUTRAL] Correct, uh, it'll be with the.
[CUSTOMER][NEUTRAL] And now, uh.
[CUSTOMER][POSITIVE] I'm just one of those people who like to document everything good.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] OK, via fax. Alright, and my fax number is [PII] and just put attention [PII].
[AGENT][NEUTRAL] OK, I'm gonna read that number back just to make sure I heard that correctly. That was [PII].
[CUSTOMER][NEUTRAL] Yes, [PII]. Yes, ma'am.
[AGENT][POSITIVE] Got it. Alrighty, I will go ahead and get that sent now. Uh, you should get it within 10-15 minutes, um, and then it will also have the claim number, check number, all of that information on there as well.
[CUSTOMER][POSITIVE] Great. And what's the reference number for the call, please?
[AGENT][NEUTRAL] Sure, it would just be my first name, last initial, and today's date. Uh, so my last initial is [PII] Was there anything else I can help you with [PII]?
[CUSTOMER][NEGATIVE] Gotcha.
[CUSTOMER][POSITIVE] Uh, no, you did a great job. I appreciate it. Have a great day. Bye.
[AGENT][POSITIVE] OK, of course, yeah, thanks for calling. You too. Bye bye.