AccountId: 011433970860
ContactId: 8b2d35ef-6d2f-4a9f-b3fc-895e865865fd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 300739 ms
Total Talk Time (AGENT): 110461 ms
Total Talk Time (CUSTOMER): 90169 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/8b2d35ef-6d2f-4a9f-b3fc-895e865865fd_20250212T16:11_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] calling from providers billing office searching for a claim service.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, [PII]. And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII] and the direct line.
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] thing?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Just a one coin.
[AGENT][NEUTRAL] OK, and may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, it's 02498570.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yes, this is for [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Yes, it's [PII] and it got billed for $56,295 and even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][NEUTRAL] it
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yes, for Medical University Hospital Authority.
[AGENT][NEUTRAL] All right, so I'm showing we received the claim.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] The claim number is 354-7315.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was paid out on?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was a total of $549.93.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And it is.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] it is.
[AGENT][NEUTRAL] That's all the information for the claim.
[CUSTOMER][NEUTRAL] And any denial because uh the primaries.
[CUSTOMER][NEUTRAL] Primaries leftover was $5,246.89. And secondly, the American public has paid $549.93 and the balance of $44,696 of spending. Is there any denial in this thing?
[AGENT][NEUTRAL] There's no denial. Um, the benefit for this policy is up to $1000 per occurrence. So the, hold on, let me go back to the claim.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So the $549.93 was the max amount that was payable for the occurrence.
[CUSTOMER][NEUTRAL] So the balance is be contractual?
[AGENT][NEUTRAL] Um, we don't determine patient responsibility. If there's an outstanding balance, it would just be whatever your protocol is on remaining or outstanding balances.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Sure. Could you help me call reference?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII], and my first name again is [PII]
[CUSTOMER][NEUTRAL] Sure. And is it possible to fax me an EOB?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's attention, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Last name is [PII].
[AGENT][NEUTRAL] And that's [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Alright, so I'll go ahead and send this over to you now. [PII], was there anything else I could assist you with today?
[CUSTOMER][POSITIVE] Uh, nothing else, [PII], thanks for asking. Take care.
[AGENT][POSITIVE] You also, and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye now.