AccountId: 011433970860
ContactId: 8a88305a-50e8-45a7-88db-52eb71c7d2ee
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 802700 ms
Total Talk Time (AGENT): 174502 ms
Total Talk Time (CUSTOMER): 180753 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/8a88305a-50e8-45a7-88db-52eb71c7d2ee_20250613T18:50_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Thank you for calling
[CUSTOMER][NEUTRAL] Uh, this is [PII] from American Family Care. I want to check the claim status of the patient.
[AGENT][NEUTRAL] OK, [PII]. Happy to check on a claim. Do you have the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, the policy number is 205.
[AGENT][NEUTRAL] OK OK.
[CUSTOMER][NEUTRAL] 436007.
[AGENT][NEUTRAL] 205436-007
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Unfortunately, that doesn't come up as a valid policy number. Do you have their name or social?
[CUSTOMER][NEUTRAL] Uh the patient's name is [PII] last [PII]
[AGENT][NEUTRAL] First name is [PII]
[CUSTOMER][NEUTRAL] No, no, [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] One moment. [PII].
[CUSTOMER][NEUTRAL] But
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Do you know what state they reside in?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] What's the patient's date of birth?
[CUSTOMER][NEUTRAL] Uh, that is [PII].
[AGENT][NEUTRAL] What's the data service?
[CUSTOMER][NEUTRAL] That is [PII] 2024.
[AGENT][NEUTRAL] And the build out.
[CUSTOMER][NEUTRAL] That is $396.96.
[AGENT][NEUTRAL] 39696.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][POSITIVE] Thank you for your patience on this. Just one more moment please.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] So it looks like the claim was received on [PII]. Claim is processed same date, [PII]. There was a benefit payment sent in the amount of $50.
[CUSTOMER][NEUTRAL] There was
[CUSTOMER][NEUTRAL] Uh, it was processed on?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, what's the allowed amount, uh, and what's the paid amount for that?
[AGENT][NEUTRAL] So the paid amount was $50 that was the maximum benefit for the date of service.
[CUSTOMER][NEUTRAL] Paid amount $55 right?
[AGENT][NEUTRAL] 5050.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what's the loan amount?
[CUSTOMER][NEUTRAL] The same?
[AGENT][NEUTRAL] 50. Mhm.
[CUSTOMER][NEUTRAL] Uh, what about the other CPT codes?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Um, the $50 was the maximum benefit paid, so there was nothing additional payable on any other code.
[CUSTOMER][NEUTRAL] Uh, the remaining, uh, is patients, uh, balance form.
[CUSTOMER][NEUTRAL] Patients responsibility.
[AGENT][NEUTRAL] We're not able to advise on patient responsibility, that's up to the facility or provider.
[CUSTOMER][NEUTRAL] Oh, and does the provider has, uh, any contract related to that?
[AGENT][NEUTRAL] I'm sorry, what was your question again?
[CUSTOMER][NEUTRAL] Uh, like, uh, it is uh like the provider has PPO contract or what I was asking about that.
[AGENT][NEUTRAL] I have no idea. You would need to check with the provider.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there any other information I can provide or help with today?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh, may I get the claim number for this?
[AGENT][NEUTRAL] 354-088-84
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh I have one more claim. Can you assist with that?
[AGENT][NEUTRAL] Let me just notate this patient and we can move on to the next one moment.
[AGENT][NEUTRAL] What is the next member ID?
[CUSTOMER][NEUTRAL] The next member ID is 02543607.
[AGENT][NEUTRAL] OK, that's the same patient, [PII].
[CUSTOMER][NEUTRAL] Oh yeah, yeah, same patient.
[CUSTOMER][NEUTRAL] And the date of service is uh [PII].
[AGENT][NEUTRAL] Fill them out.
[CUSTOMER][NEUTRAL] That is $217.
[CUSTOMER][NEUTRAL] Even
[AGENT][NEUTRAL] Claim is received on [PII].
[AGENT][NEUTRAL] Claim is processed [PII].
[AGENT][NEGATIVE] Claim was denied. Patient was not active at the date of service. Patients plan terminated [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I get claim number?
[AGENT][NEUTRAL] 353-882-6.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Anything else?
[CUSTOMER][NEUTRAL] I have one more claim. Can you one more last one.
[AGENT][NEUTRAL] Policy number?
[CUSTOMER][NEUTRAL] Uh, one moment, I'll pull it up.
[CUSTOMER][NEUTRAL] The policy is 02457763.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] Uh name is [PII] and the last name is [PII]
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] Uh, date of service is [PII].
[AGENT][NEUTRAL] And what's the build amount?
[CUSTOMER][NEUTRAL] Bill amount is $140.50.
[AGENT][NEUTRAL] All right, so it looks like we did get a claim for this state of service. It was received on [PII].
[CUSTOMER][NEUTRAL] We
[AGENT][NEUTRAL] Processed [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, can you repeat once?
[AGENT][NEUTRAL] Claim was received [PII].
[CUSTOMER][NEUTRAL] It.
[AGENT][NEUTRAL] Claim is processed [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, what's the allowed amount and the paid amount for that?
[AGENT][NEGATIVE] And the claim was denied. Patient was not eligible for benefits at the time of service. Patient's plan, uh, terminated on.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, can I get claim number?
[AGENT][NEUTRAL] 351.
[AGENT][NEUTRAL] 3409.
[CUSTOMER][NEUTRAL] OK. Uh, can I get call reference?
[AGENT][NEUTRAL] Call reference is my name with today's date.
[CUSTOMER][POSITIVE] Thank you for assisting me. Have a nice day.
[AGENT][POSITIVE] You as well take care bye bye.
[CUSTOMER][NEUTRAL] Right.