AccountId: 011433970860
ContactId: 8245b4ee-6290-4c8d-8a2e-11eb0bd80fcb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 472260 ms
Total Talk Time (AGENT): 158494 ms
Total Talk Time (CUSTOMER): 116358 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/8245b4ee-6290-4c8d-8a2e-11eb0bd80fcb_20250131T15:02_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I'm calling from provider office. I want to know the payment status. Can you please help on this?
[AGENT][NEUTRAL] Sure, OK.
[AGENT][NEUTRAL] Yes, I can assist you with claims, Mr. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Thank you and may I have the name of the facility or the place you're calling from?
[CUSTOMER][NEUTRAL] It's all sent home Medical.
[AGENT][NEUTRAL] O Central Medical.
[CUSTOMER][NEUTRAL] All sent Home Medical.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK. And may I have the patient's policy number, Mr. [PII]?
[CUSTOMER][NEUTRAL] It's 02049543.
[AGENT][NEUTRAL] OK. Thank you. One moment.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] The patient name is [PII].
[CUSTOMER][NEUTRAL] A and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The date of service is [PII].
[CUSTOMER][NEUTRAL] of [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] So [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and what is the maximum or the amount?
[CUSTOMER][NEUTRAL] The bill amount is 369 dollars.25.
[CUSTOMER][NEUTRAL] 1.25 cents.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Waiting on the you'll be.
[AGENT][NEUTRAL] Yeah, we process the claim on [PII], we send a benefit amount of $7.69.
[AGENT][NEUTRAL] And with that payment, the maximum benefit outpatient benefits has been exhausted for the year.
[CUSTOMER][NEUTRAL] And how much is the total amount for this?
[AGENT][NEUTRAL] We're not the major medical. We are the secondary. There's not an allowed amount. Uh, we pay $7.69 which was the remaining balance of the outpatient maximum benefit. With that payment, the member has exhausted the benefit for the year.
[CUSTOMER][NEUTRAL] So what is the total amount you paid you the benefits for the benefits?
[AGENT][NEUTRAL] I'm sorry, can you repeat?
[CUSTOMER][NEUTRAL] What is the total amount that you paid for the
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] How much is the total amount we pay for the claim?
[CUSTOMER][NEUTRAL] Yeah, for the year you are all diagnosed.
[AGENT][NEUTRAL] Are you are you asking, are you asking about the calendar year maximum for the policy or you're asking for the amount that we send out in the payment?
[CUSTOMER][NEGATIVE] The payment was exhausted.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, maximum for the calendar year.
[AGENT][NEUTRAL] The calendar year maximum. OK, one moment.
[AGENT][NEUTRAL] OK, the calendar year maximum on this one is 4500.
[CUSTOMER][NEUTRAL] 1500.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] What, what is the amount, 15, only 500.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Can you please uh
[CUSTOMER][NEUTRAL] Provide the claim received it.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Only for 431, E431, or the whole claim you are paid the 500 for the per year.
[AGENT][NEUTRAL] I'm sorry, I, I cannot understand what you're trying to say. Can you repeat?
[CUSTOMER][NEUTRAL] Uh, and you can pay for the E 0431.
[CUSTOMER][NEUTRAL] Or you are paid the all the all the calendar year of the, for the whole claims.
[AGENT][NEUTRAL] A calendar year maximum for outpatient service is for any outpatient claims we received. So that maximum is for any claims received during the year for outpatient service.
[AGENT][NEUTRAL] When we got your claim, when we got your claim, she only has $7.69 remaining from that maximum, and that's what we send, the $7.69.
[CUSTOMER][NEUTRAL] It's the only 500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Can you please provide the claim received it. Let me check.
[AGENT][NEUTRAL] Yes, it was received [PII], processed [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Receive [PII], processed [PII].
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] Mm, same number.
[AGENT][NEUTRAL] That is 35353-9132.
[CUSTOMER][NEUTRAL] Claim number?
[CUSTOMER][NEUTRAL] OK, allow me a minute and let me check the details.
[AGENT][NEUTRAL] Mhm. Sure.
[CUSTOMER][NEUTRAL] OK. Can you please provide the call reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name and today's date if you will.
[CUSTOMER][NEUTRAL] So there is no call reference number.
[AGENT][NEUTRAL] No, you can use my name in today's date if you will, Mr. [PII].
[CUSTOMER][NEUTRAL] OK, can you please provide the, can you please spell your name just?
[AGENT][NEUTRAL] Sure. That's [PII]. That's initial [PII].
[CUSTOMER][POSITIVE] It's [PII]. OK. Thank you.
[AGENT][POSITIVE] Alright. You're welcome. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] No, thank you, just
[AGENT][POSITIVE] You're welcome. Thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] OK, thank you.