AccountId: 011433970860
ContactId: 72605534-3712-4384-aa3c-92f17c168ae3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 381420 ms
Total Talk Time (AGENT): 157514 ms
Total Talk Time (CUSTOMER): 109040 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/72605534-3712-4384-aa3c-92f17c168ae3_20250116T13:56_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from provider's office account claim status. How are you doing today?
[AGENT][POSITIVE] I'm doing great and I am so sorry I did not catch your name.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oh, I
[AGENT][POSITIVE] Hi, [PII], thank you so much for that information. Go ahead and give me a good policy number, please, sir.
[CUSTOMER][POSITIVE] Thank you so much for
[CUSTOMER][NEUTRAL] So what's the good name, sir, sorry?
[AGENT][NEUTRAL] I need the member's policy number.
[CUSTOMER][NEUTRAL] Yeah, what's your name?
[AGENT][NEUTRAL] My name is [PII]. That's [PII] yes.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Sure, [PII], go ahead with that policy number.
[CUSTOMER][NEUTRAL] That's it.
[CUSTOMER][NEUTRAL] Yeah, the policy number is 024.
[CUSTOMER][NEUTRAL] 650
[CUSTOMER][NEUTRAL] 28
[CUSTOMER][NEUTRAL] M as in Mike. I as in India. 8.
[AGENT][POSITIVE] All right, [PII], thank you so much for that information. Now while I'm pulling this information up, go ahead and give me a good return telephone call number.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And the extension is [PII].
[AGENT][NEUTRAL] Alrighty, [PII], thank you for that information. Now what's your patient's name and date of birth today, please, sir?
[CUSTOMER][NEUTRAL] The patient's name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] All righty, and thank you for that, [PII]. And you did say you want to check status of a claim. Is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] The date of service is [PII] and the bill amount is $500 even.
[AGENT][NEUTRAL] Alrighty, give me just a moment to check on that for you, [PII]. Let's see.
[CUSTOMER][NEUTRAL] No, give me just a moment
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] That data service.
[AGENT][NEUTRAL] You said your total bill is $500.
[CUSTOMER][NEUTRAL] These
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And I think I see it paid.
[AGENT][NEUTRAL] Yeah, it looks like there's a $50 check that went out. Let me see what day this was paid on.
[CUSTOMER][NEUTRAL] It looks like there's a $50.
[CUSTOMER][NEUTRAL] what
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 200.
[AGENT][NEUTRAL] Yeah, $50 check is dated [PII]. A payable to the provider's office that has been cashed.
[CUSTOMER][NEUTRAL] Yeah, be.
[AGENT][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] OK. Well, what is the received date then process that is like that.
[AGENT][NEUTRAL] Well, uh, process date is [PII].
[AGENT][NEUTRAL] Received date is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You want the claim number?
[CUSTOMER][NEUTRAL] Yeah, what is the claim number?
[AGENT][NEUTRAL] Yeah, claim number 351.
[AGENT][NEUTRAL] 2809.
[CUSTOMER][NEUTRAL] It's 351-2809, right?
[AGENT][POSITIVE] That is correct, [PII]. Yes, sir.
[CUSTOMER][POSITIVE] OK, thank you so much. What is the remaining balance is $10?
[AGENT][NEUTRAL] I'm sorry, what was your question, [PII]?
[CUSTOMER][NEUTRAL] We submitted the $60 co-pay. You have to only paid for $50.
[AGENT][NEUTRAL] Yeah, $50 is the max here.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That is the max benefit on an office visit payable under the plan.
[CUSTOMER][NEUTRAL] No, but what one will do for the $10 is remaining you any denial for this one you any co-pay and deductible process this $10.
[AGENT][NEGATIVE] Yeah, the $10 is patient responsibility. It's not covered here.
[CUSTOMER][NEUTRAL] OK, there is any co-pay for deductible?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] It's deductible, right?
[AGENT][NEUTRAL] It's not deductible, no, sir.
[CUSTOMER][NEUTRAL] It's only patient responsibility.
[AGENT][NEUTRAL] Right, correct. We're only gonna pay $50 out of the $60 that's all that's covered under her plan here.
[CUSTOMER][NEUTRAL] OK, maximum $50 covered in the member plan, right?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Is there anything else that I can help answer for you today, [PII]?
[CUSTOMER][NEUTRAL] Yeah, you can fax you'll be the fax number is.
[CUSTOMER][NEUTRAL] 305.
[CUSTOMER][NEUTRAL] 6756275
[AGENT][POSITIVE] Alrighty, [PII], give me about 5 minutes and I'll get it over to you, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Alrighty, [PII]. Well, thank you for calling APO and you have a great rest of your day, OK?
[CUSTOMER][NEUTRAL] What is the call reference number?
[AGENT][NEUTRAL] Oh we do not give call reference numbers, [PII], but you can use my name in today's date, OK?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][POSITIVE] Yes sir, [PII], and thanks for calling APR. You have a great rest of your day.