AccountId: 011433970860
ContactId: 734fc5dc-8c07-4c8c-b678-a8972538fd50
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 461799 ms
Total Talk Time (AGENT): 179706 ms
Total Talk Time (CUSTOMER): 118541 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/734fc5dc-8c07-4c8c-b678-a8972538fd50_20250319T20:02_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from the provider's office of uh Care Plus to check on a claim status. Please be informed that this call will be recorded and monitored for quality and training purposes.
[AGENT][NEUTRAL] OK, and I can verify claim status for you and you say your name is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what is that policy number, please?
[CUSTOMER][NEUTRAL] Policy number is uh
[CUSTOMER][NEUTRAL] 0179221110.
[AGENT][NEUTRAL] OK, thank you. Well, that's too many numbers. Do you have a copy of the card in front of you?
[CUSTOMER][NEUTRAL] Let me check.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I do have a copy of a card, but I can't able to find the member ID on that.
[AGENT][NEUTRAL] And look at the bottom. Do you see at the bottom of the card, do you see it inhospital outpatient benefit certificate number?
[CUSTOMER][NEUTRAL] I do have a policy number, a group number.
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] Effective date
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 2110.
[AGENT][NEUTRAL] OK, you gave me an extra 2 with that policy number. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Callback number is [PII].
[AGENT][NEUTRAL] Thank you, and verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] So first name is [PII] and last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] So data service is uh [PII].
[AGENT][NEUTRAL] Amount of the charge.
[CUSTOMER][NEUTRAL] $30 even.
[AGENT][NEUTRAL] OK, one moment, please. And while I'm looking up claim information and let you know we do have an online service center where providers can check claim status as well as print out the EOB. That site is at secured. Am as [PII].
[AGENT][NEUTRAL] And what's the name of the provider's office?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's cat plus uh pediatrics.
[AGENT][NEUTRAL] I'm sorry, what is that again?
[CUSTOMER][NEUTRAL] Care plus pediatrics.
[AGENT][NEUTRAL] OK, I show this claim paid $30 and this was processed on.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Speed is $30 and allowed amount also it will be $30 right?
[AGENT][NEUTRAL] Well, I don't know about that amount, but the amount paid was $30.
[CUSTOMER][NEUTRAL] OK. So you can't be able to find the allowed amount on it.
[AGENT][NEUTRAL] We don't have an allowed amount. The amount that was paid was on this claim was $30.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Even though there's no patient responsibility on it, uh.
[AGENT][NEUTRAL] Let me pull up this claim, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Per the claim, the total charge was $174. After primary process the claim, the amount was $30 that they applied towards her.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] That was the amount applied towards the copay and that's what we paid as secondary was the $30 that they applied towards the copay.
[CUSTOMER][NEUTRAL] So this is $30 as a co-pay, right? OK.
[AGENT][NEUTRAL] $30 is the benefit max that we paid for this claim. It's not a co-pay, it was a co-pay for the primary, but it's the benefit payable for secondary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So is there any check number for this?
[AGENT][NEUTRAL] Check number is 2031975.
[CUSTOMER][NEUTRAL] OK. Thank you. Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And whether it's a bulk payment or a single payment.
[AGENT][NEUTRAL] Single.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Could be able to verify me the pay to address of the provider?
[AGENT][NEUTRAL] Sure, one moment.
[AGENT][NEUTRAL] Uh, the check was sent to [PII].
[CUSTOMER][NEUTRAL] And can you able to send me a copy of your B to us?
[AGENT][NEUTRAL] As I stated, we do have an online service center where providers can check claim status as well as print out the EOB. That site is at [PII].
[CUSTOMER][NEUTRAL] Sorry, could you repeat that one?
[AGENT][NEUTRAL] Sure, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it. So I need to get this from this, OK.
[AGENT][NEUTRAL] OK, and is there anything else I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] No, that's it about the information and could you please spell your name once.
[AGENT][NEUTRAL] Sure, it's [PII].
[CUSTOMER][NEUTRAL] be able to find the call reference for this claim?
[AGENT][NEUTRAL] You can use my name in today's date as call reference.
[CUSTOMER][NEUTRAL] OK. Is there any claim number on this?
[AGENT][NEUTRAL] 3573638
[CUSTOMER][POSITIVE] Thank you, got it.
[AGENT][POSITIVE] You're welcome. Thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh sorry, what will be the call reference?
[AGENT][NEUTRAL] You can use my name and today's date as call reference.
[CUSTOMER][POSITIVE] OK. Thank you. Thank you.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Bye.
[CUSTOMER][NEUTRAL] Bye.