AccountId: 011433970860
ContactId: 8ab7a336-3438-441b-834d-abfff0802f66
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 424750 ms
Total Talk Time (AGENT): 131639 ms
Total Talk Time (CUSTOMER): 147144 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/8ab7a336-3438-441b-834d-abfff0802f66_20250604T17:04_UTC.wav
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[AGENT][POSITIVE] Good. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] OK. Hi, [PII]. My name is [PII]. I'm calling for the provider's office to check on a claim clarification. Please note this call will be monitored and recorded for quality and training purposes.
[AGENT][NEUTRAL] OK, [PII], are claim status or do you already know that are you or are you needing additional information?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I just wanted a clarification.
[AGENT][POSITIVE] Yes ma'am, I can help you with that and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] It is [PII] and the extension is [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] Yes, and the
[CUSTOMER][NEUTRAL] Member's policy number is 02433210.
[AGENT][NEUTRAL] Did you say 02433210?
[CUSTOMER][NEUTRAL] Yes, it is correct. 02433210.
[AGENT][NEUTRAL] Thank you. Um, any information that I do provide for you today, [PII] would be a verification of benefits and not a guarantee of payment. What is the patient's name, date of birth?
[CUSTOMER][NEUTRAL] The patient's name is [PII] and date of birth is on [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Yes. And the date of service is on [PII]. And the total bill amount is
[CUSTOMER][NEUTRAL] $584 even.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, [PII], do you already have the claim number for this data service?
[CUSTOMER][NEUTRAL] Already have
[CUSTOMER][NEUTRAL] Yes, and the claim number is 3584431.
[AGENT][NEUTRAL] OK, yes, ma'am. So how can I help you with that claim today?
[CUSTOMER][NEUTRAL] Yes, I just wanted a clarification that uh for all of the CPT codes, there is no leftover payment for, from the primary insurance, but we have received a payment of $500 257 dollars 83 cents through the check number 2036898 and the claim number which I have provided earlier.
[CUSTOMER][NEUTRAL] Uh, from my end, it was showing the primary is UHC and we have received a payment from the UHC. And there is no leftover payment for any of the CPT codes.
[AGENT][NEUTRAL] OK, so let me look at the document. This policy helps with the co-pays, deductibles and co-insurance amount of coverage services.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So you're saying that it was
[AGENT][NEUTRAL] Paid in full.
[AGENT][NEUTRAL] There was nothing applied to the deductible, co-pay or co-insurance?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, from my end, it was showing that there is no leftover payment from the primary insurance.
[AGENT][NEUTRAL] OK, give me a moment please to see if I can pull up this information.
[CUSTOMER][NEUTRAL] Uh, may I know how you have processed this claim? Is it primary or secondary?
[AGENT][NEUTRAL] We were, we are not a major medical insurance. This is a secondary insurance, but it's a supplemental policy that helps with the co-pays, deductibles, and co-insurance amounts of covered services.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Can you please check this one? Is there any
[CUSTOMER][NEGATIVE] Co-pay or deductible applied from the primary insurance, but from my end, it was not showing anything.
[AGENT][NEUTRAL] Uh, yes, ma'am, on the information that we received, yes, with the claim.
[AGENT][NEUTRAL] And that is what the benefit payment is for.
[CUSTOMER][NEUTRAL] OK. So, is there any future equipment?
[AGENT][NEUTRAL] I'm sorry, what was your question?
[CUSTOMER][NEUTRAL] Is there any future equipment?
[AGENT][NEUTRAL] Uh, I'm so sorry. I'm not understanding you, [PII].
[CUSTOMER][NEUTRAL] Is there any future takeback in this payment?
[AGENT][NEUTRAL] Future.
[AGENT][NEUTRAL] What is the rest of it?
[CUSTOMER][NEUTRAL] Is there any future takeback?
[AGENT][NEUTRAL] Take back
[AGENT][NEUTRAL] Is that what you're asking?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Not that I can see.
[CUSTOMER][NEUTRAL] Take back
[AGENT][NEUTRAL] The uh based on the explanation of benefits that we received this claim was processed correctly.
[CUSTOMER][POSITIVE] OK. Thank you for that information.
[CUSTOMER][NEUTRAL] Can I get the call reference number?
[AGENT][NEUTRAL] Yes, ma'am. It will be my name along with today's date.
[AGENT][NEUTRAL] And if you need a copy of the explanation of benefits, you should be able to print that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] By going to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][POSITIVE] OK. Well, you're very welcome. And is there anything else, [PII] that I can help you with?
[CUSTOMER][NEUTRAL] No, [PII]. Thank you for that information.
[AGENT][POSITIVE] Well, you're very welcome and thank you for calling with excuse me, calling APL and I hope you have a nice day.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] Mhm, bye-bye.