AccountId: 011433970860
ContactId: 8553e9cc-459c-4e89-9c75-f643df46db1c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 290190 ms
Total Talk Time (AGENT): 124155 ms
Total Talk Time (CUSTOMER): 71161 ms
Interruptions: 0
Overall Sentiment: AGENT=2.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/8553e9cc-459c-4e89-9c75-f643df46db1c_20250131T13:33_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning [PII]. My name is [PII]. I'm calling to check the status on a claim that was submitted for a patient, and I'm calling from McCloud Medical Center, Clarendon.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, [PII], so you're calling to check claim status. Is that correct for one member?
[CUSTOMER][NEUTRAL] Yeah, yes.
[AGENT][POSITIVE] Yes ma'am, I can help you with that. And [PII], what is your callback number please?
[CUSTOMER][NEUTRAL] My direct number will be [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] Policy is 02219654.
[AGENT][POSITIVE] Alright, thank you. Give me a couple of moments to get the member's information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information that I do provide for you today will be a verification of benefits, [PII], and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEGATIVE] Not like stems.
[CUSTOMER][NEUTRAL] And her date of birth is [PII].
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her, please?
[CUSTOMER][NEUTRAL] OK, this is [PII]. The original bill amount was $20,575 even.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] OK, so this claim was received on [PII]. It was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3553041.
[AGENT][NEUTRAL] And let's see.
[AGENT][NEUTRAL] Right
[AGENT][NEUTRAL] The benefit amount paid on this was $165.56.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And the remark on this claim states the maximum outpatient, excuse me.
[AGENT][NEUTRAL] The maximum amount payable for this occurrence has been met.
[CUSTOMER][NEUTRAL] OK, so it was back max benefits is why it didn't pay anymore, OK.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So the patient is gonna be responsible for the balance.
[AGENT][NEUTRAL] We do not determine patient responsibility. That would be up to the provider since this is a supplemental policy, and [PII], if you need a copy of this explanation of benefits if you've not received that yet, you can print it from our portal by going to [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, now do you give a call reference number?
[AGENT][NEUTRAL] Yes, ma'am, you would use my name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] You did say [PII], correct?
[AGENT][NEUTRAL] I did, yes, ma'am.
[CUSTOMER][NEUTRAL] And I'm sorry, tell me that website again because we did, we did not get that um remit.
[AGENT][NEUTRAL] Se
[AGENT][POSITIVE] Secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you so much.
[AGENT][POSITIVE] Alright, well, you are certainly very welcome and is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] That's it. I hope you have a great day.
[AGENT][POSITIVE] I hope you do too, and thank you again for calling APL. I hope you have a great weekend as well.
[CUSTOMER][NEUTRAL] OK. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.