AccountId: 011433970860
ContactId: 80228f2c-1067-40e2-910f-777d77470936
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 762960 ms
Total Talk Time (AGENT): 252315 ms
Total Talk Time (CUSTOMER): 158017 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/80228f2c-1067-40e2-910f-777d77470936_20250619T20:52_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, this is [PII] calling from provider office. I want to check the claim status.
[AGENT][NEUTRAL] OK, [PII], you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Hm?
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] Yeah, [PII] and it's a direct line.
[AGENT][NEUTRAL] Thank you. And how many claims, [PII], do you have to check status on?
[CUSTOMER][NEUTRAL] Only one.
[AGENT][NEUTRAL] OK, and what is that member's policy number, please?
[CUSTOMER][NEUTRAL] Yeah, the member ID would be.
[CUSTOMER][NEUTRAL] 02148521 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you, [PII]. One moment while I get the member's information pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sending the information [PII] that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient name would be.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the date of birth would be [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her, please?
[CUSTOMER][NEUTRAL] Yeah, the data service would be [PII] and the total charge amount would be $1920 even.
[AGENT][NEUTRAL] 1920. Is that correct?
[CUSTOMER][POSITIVE] Yeah, that's right.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so this claim was received, [PII]. The received date was [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3603.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 378.
[AGENT][NEUTRAL] The benefit amount paid on this claim was 210 dollars.03 cents.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That was on single check, 204-549-4.
[CUSTOMER][NEUTRAL] Is the check number 304-5494 right?
[AGENT][NEUTRAL] 204-549-4.
[CUSTOMER][NEUTRAL] Yeah, got it. May I, may I have a low amount for this patient?
[AGENT][NEUTRAL] I'm so sorry, what was your question?
[CUSTOMER][NEUTRAL] Allowed amount.
[AGENT][NEUTRAL] This is a supplemental policy that helps with co-pays, deductibles, and co-insurance amounts of covered services.
[AGENT][NEUTRAL] And the 210.03 was the benefit to be paid on this claim.
[CUSTOMER][NEUTRAL] Sorry, how much pay, pay a month?
[AGENT][NEUTRAL] 210 dollars.03 cents.
[AGENT][NEUTRAL] We are the supplemental policy.
[CUSTOMER][NEUTRAL] There is any patients.
[AGENT][NEUTRAL] This is a supplemental plan.
[AGENT][NEUTRAL] That helps with the co-pays, deductibles, and co-insurance amounts of covered services.
[AGENT][POSITIVE] And on this claim that was the most benefit.
[CUSTOMER][NEUTRAL] yeah.
[CUSTOMER][NEUTRAL] I'm still confusing for this one you said, uh, paid amount is, uh, benefit amount is 2, yeah, yeah, paid amount is $210.03 right? And the balance amount, yeah.
[AGENT][NEUTRAL] I'm saying we paid.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Correct, because that is the amount applied. There is no balance on this invoice. There is no balance. That was the adjusted amount on this invoice I mean excuse me, on this explanation of benefits for for the primary insurance company.
[AGENT][NEUTRAL] This is a supplemental policy. This is not her primary insurance.
[CUSTOMER][NEUTRAL] Just a moment, ma'am. You said uh
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 190 minus.
[CUSTOMER][NEUTRAL] The balance is 1,709.
[CUSTOMER][NEUTRAL] Dollar 97 cents has been discounted provider, right.
[AGENT][NEUTRAL] We don't do discounts on the supplemental plan.
[CUSTOMER][NEUTRAL] For what amount, ma'am, for this one only paid $210.03.
[AGENT][NEUTRAL] That was the adjust amount on the primary explanation of benefits.
[AGENT][NEUTRAL] That was the deductible, $210.03.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] And this policy only?
[CUSTOMER][NEUTRAL] Paid as your deductible.
[AGENT][NEUTRAL] Again, I don't know how else to explain it, [PII]. This policy only helps with the co-pay, deductible and co-insurance amounts. And on this claim on the primary insurance company's EOB, the $210.03 was the deductible.
[AGENT][NEUTRAL] Amount.
[CUSTOMER][NEUTRAL] You say deducted amount for this one. How the, uh, you, you say the check number and the this one you said paid only that we need to provide the check number, right?
[AGENT][NEUTRAL] Do you need the check number? I gave you the check number. Do you want me to give you the check number again?
[CUSTOMER][NEUTRAL] No, ma'am, uh, if that claim only paid, paid only check number is gene, right, so you say the deductible of the claim has been paid.
[AGENT][NEUTRAL] I'm saying that the $210.03 that the benefit was paid, that we paid.
[AGENT][NEUTRAL] Was the deductible amount on her explanation of benefits from her primary insurance company for this state of service on this claim?
[CUSTOMER][NEUTRAL] We got
[CUSTOMER][NEUTRAL] Just a moment, ma'am.
[CUSTOMER][POSITIVE] Yeah, yeah, ma'am, ah, thanks for your patience. May I have a pets for this one?
[CUSTOMER][NEUTRAL] Check that address.
[AGENT][NEUTRAL] I just, yes, so I gave you the amount that was paid on this claim. I've given it to you multiple times, [PII], and I gave you the check number that we paid and if you need a copy of that explanation of benefits, you can go to our portal and use that claim number to print that out and our website for the portal is secured. [PII].
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hm?
[CUSTOMER][NEUTRAL] OK. Hmm.
[CUSTOMER][NEUTRAL] Mhm, you don't fax you'll be right.
[AGENT][NEUTRAL] It's preferred that you print it. Mhm.
[CUSTOMER][NEUTRAL] Yeah, I got it. Ma'am, may I know your good name, ma'am?
[AGENT][NEUTRAL] By using the claim number.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Again my name is [PII], and you will use my name along with today's date as your call reference number.
[CUSTOMER][NEUTRAL] Could you please uh spell that one, ma'am? [PII], right?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Last name initial?
[AGENT][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] And, uh, yes, sir, uh, [PII], and you said the check issue date, ma'am.
[AGENT][NEUTRAL] Again, that check was issued on [PII] and it cleared on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yeah, got it.
[CUSTOMER][POSITIVE] Uh, thanks for your information. Please have a great day. Bye-bye.
[AGENT][POSITIVE] OK, well then, thank you for calling APL if that is all I can help you with, and I hope you have a nice evening as well.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh-huh. Bye-bye.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um, actually I do, I have only one disclaim for that.
[AGENT][POSITIVE] OK, well then, thank you for calling APL and I hope you have a nice evening, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.