AccountId: 011433970860
ContactId: 824bdc0e-7808-4775-9238-2b8b72771d15
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1137750 ms
Total Talk Time (AGENT): 288293 ms
Total Talk Time (CUSTOMER): 416636 ms
Interruptions: 7
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/824bdc0e-7808-4775-9238-2b8b72771d15_20250310T13:46_UTC.wav
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[AGENT][POSITIVE] Good Morning, thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, ma'am. My name is [PII]. I'm calling for Doctor [PII], uh, to check on a claim followup. Please be informed that this call is being recorded and monitored for quality and training purposes. May I know if I can help you with the patient's information or provider's information?
[CUSTOMER][NEUTRAL] Some.
[AGENT][NEUTRAL] Um, yeah, um, I didn't really understand the last part you said, Mr. [PII], but I can assist you with claim status. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, sure. The callback number is [PII]. And sorry for that. Uh, the last part is I need the additional information regarding this claim on follow-up.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so you need the claim status information?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. May I have the patient's policy number, Mr. [PII]?
[CUSTOMER][NEUTRAL] Yeah, sure. The patient's policy number, uh, member ID number is 00945668.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] OK, you're welcome. Ma'am, could you please spell your name for me?
[AGENT][NEUTRAL] Sure. That's [PII], last initial [PII].
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][POSITIVE] OK. Thank you very much, sir.
[AGENT][NEUTRAL] You're welcome. And may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah, sure. Name of the patient here is uh [PII] and date of birth is [PII].
[AGENT][POSITIVE] Alright thank you.
[AGENT][NEUTRAL] May I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yeah, sure, the date of service here is [PII], and the bill amount is just a moment. System's loading here. OK. The bill amount here is $1,826 even.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so that's [PII] for 1,826.
[CUSTOMER][POSITIVE] Yes, perfect.
[AGENT][NEUTRAL] OK, let me see if I can find this claim. And for future, you can check claim status online through our website at [PII] and that's just optional.
[AGENT][NEUTRAL] Um yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you very much.
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] Let me look at this claim. Do you know what's the procedure code of the claim?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, uh, I don't have any procedure code here. Uh, just a moment here. I had to check. OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I just have the claim number here.
[AGENT][NEUTRAL] OK, what's the claim number?
[CUSTOMER][NEUTRAL] Do you
[CUSTOMER][NEUTRAL] OK, claim number is 3549.
[CUSTOMER][NEUTRAL] 3 consecutives, 3.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] So it's procedure code 64483 and 64484.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, just a moment, I'll check.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][POSITIVE] Yes, perfect. So.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it looks like we have sent a benefit amount of let's see.
[AGENT][NEUTRAL] $101.70 yeah, it's fully paid, yeah, within 16605. Mhm.
[CUSTOMER][NEUTRAL] So the claim is paid, right?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. OK, thank you very much, sir. Just a moment here. Uh, sorry for interruption because I don't want you to, uh, repeat all the information so many times. Just a moment. I'll get it one by one. OK, thank you very much for this understanding.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] Just a moment. So that's the previous follow up, uh, the received date is, uh, [PII], right?
[AGENT][NEUTRAL] Mm, let me check.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You receive the.
[CUSTOMER][NEUTRAL] You.
[AGENT][NEUTRAL] It is 333 and here we go. [PII] February, January. I do apologize. It's [PII] and processed [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, thank you very much for correcting me. Let me just reconfirm you and the received date as you see here is uh [PII], right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Correct, yes, and it was processed on [PII]. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, processed on [PII]. Thank you very much. May I know the claim paid date?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's the same date as the process date [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you, just a moment.
[CUSTOMER][NEUTRAL] May I know the allowed amount?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, the amount we have paid is 16605.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] $166.05. Thank you very much for this information.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm, no, you have paid. Uh, you just gave me the paid amount. May I know the other amount?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, we're not the major medical. We are the secondary, um, so that is the amount that was supplied towards the deductible co-payment and co-insurance and that's what we pay.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hey
[CUSTOMER][NEUTRAL] But they
[CUSTOMER][NEUTRAL] OK, so this amount is applied towards the deductible, right?
[AGENT][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mr. [PII], we are not the major medical. OK, so we're not the major medical, so what we do is we help out with the deductibles, co-payment, and co-insurance from the major medical. So the amount that the major medical applied towards the deductible co-payment and coinsurance was $166.05 and that's what we pay.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, thank you very much. So the amount is also the same.
[AGENT][NEUTRAL] It should be under the major medical, um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, one moment. I'll have to search for that AOB because um yeah, we're not major medical. We don't, we don't have that information like available to us like that. We had to search.
[CUSTOMER][NEUTRAL] OK, please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. I will wait till now.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, based on the primary explanation of benefits, they apply $166.05 towards the patient's responsibility, and that's what we paid.
[CUSTOMER][NEUTRAL] OK, thank you very much. Uh, so, could you please allow me a moment? I have to check for this one more time so that I can get the required information from you. OK, thank you very much.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Thank you very much, uh, so, for your, uh, holding and really appreciate your patience. So you don't have the other amount, right? Because you're not a major, yeah, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, yeah, we're not the major medical, so no, we don't have that information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK, just a because.
[CUSTOMER][NEUTRAL] There you are.
[CUSTOMER][POSITIVE] Major medical. Thank you very much.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the paid amount is this is $166.05 right?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] OK, and there is no patient responsibility, copy for insurance or deductible, right?
[AGENT][NEUTRAL] Not with us. Correct.
[CUSTOMER][NEUTRAL] OK. Thank you very much. Just a moment. OK. May I know the payment is by check or EFT?
[AGENT][NEUTRAL] It's a check, it's a single check paper check.
[CUSTOMER][NEUTRAL] OK. It's a check. May I know the check number?
[AGENT][NEUTRAL] Yes, 2,021,920.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 2,021,920. May I know the payment is a check or bulk amount? It is a bulk amount, right?
[AGENT][NEUTRAL] Is a single check a paper check?
[CUSTOMER][NEUTRAL] OK, just single amount.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] So it is a single amount and the single amount is $166.05 right?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] OK, thank you very much, sir. And may I know the payment's mailing address?
[AGENT][NEUTRAL] OK, the address where we send the check was to [PII].
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] Just [PII]. OK, let me just reconfirm you, uh, the payment's mailing address is [PII], right?
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][NEUTRAL] OK. Thank you very much, sir, for confirming. Could you please uh verify the patient's account number?
[AGENT][NEUTRAL] Um, yes, um, the number is
[AGENT][NEUTRAL] 235975 V as in Victor 6475 is your patient's account number.
[CUSTOMER][NEUTRAL] OK, uh, before 6475 there is 2, right?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 26475, yes.
[CUSTOMER][NEUTRAL] Yes, OK. Thank you very much for confirming, yeah. So, so, uh may I know the payment clear or cash date?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I don't see in our system that it's been cashed just yet.
[CUSTOMER][NEUTRAL] OK, so you don't have the cash date, right? Just for the documentation you're asking? OK, thank you very much.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Yes, correct. Mhm.
[CUSTOMER][NEGATIVE] Don't have it.
[CUSTOMER][NEUTRAL] Uh, could you please send us the, uh, duplicate AB for this payment by our fax number?
[AGENT][NEUTRAL] A what? I'm sorry. What did you need, sorry?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, uh, could you please send us the, uh, duplicate UB for this payment through our fax number?
[AGENT][NEUTRAL] OK. Um, yes, I can send you a copy of the EOB. What is the fax number?
[CUSTOMER][NEUTRAL] It is [PII]. Attention to the patient's account number.
[AGENT][NEUTRAL] OK, I'm sorry. Can you repeat that one more time? 866-825.
[CUSTOMER][POSITIVE] Yeah, sure, no problem.
[CUSTOMER][NEUTRAL] 486 9.
[AGENT][NEUTRAL] 369. OK.
[CUSTOMER][NEUTRAL] Attention to the patient's account number.
[AGENT][NEUTRAL] And you said it's patients account number. OK. Do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Yeah, sure, take your time, no problem.
[AGENT][NEUTRAL] OK, thank you, one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me, Mr. [PII]. I wanna go ahead and send that over to you. It should be there in a few minutes. Is there anything else I'm gonna help you with today?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, thank you very much. Uh, so for this, uh, when we are going to expect it in, uh, at our end.
[AGENT][NEUTRAL] A few minutes.
[CUSTOMER][NEUTRAL] Uh, few minutes. Thank you very much. Just had to mention the same here. OK, a few minutes. OK, and the claim number is 354-9333, right?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][POSITIVE] OK. Thank you very much, sir. May I know the conference number for this one?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK. Your name is [PII], [PII] and uh the last initial is [PII], right?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK and the date [PII]. Thank you very much. So for this information. Um, just a moment. I have to check is there anything missing from my India? OK. OK, just a moment.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you very much [PII] for your assistance. Have a great day. Take care. Bye bye.
[AGENT][POSITIVE] You're welcome. You as well and thank you for calling APO. Bye-bye, Mr. [PII].