AccountId: 011433970860
ContactId: 94c3ecc8-188f-46dd-9ec0-ec30f09aa114
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 589960 ms
Total Talk Time (AGENT): 222991 ms
Total Talk Time (CUSTOMER): 161544 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/94c3ecc8-188f-46dd-9ec0-ec30f09aa114_20250513T17:02_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, this is [PII] calling from provider's office to check up on a claim status. Also, this call has been recorded call.
[AGENT][NEUTRAL] OK, I can check on a claim for you. Um, I'm sorry, what was your name?
[CUSTOMER][NEUTRAL] Uh, just give me a moment.
[CUSTOMER][NEUTRAL] Just give me a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, thank you so much.
[AGENT][NEUTRAL] Sure. Can I get your name please? I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, my name is [PII]. Yeah, yeah, it's [PII], initial of my last name would be [PII].
[AGENT][NEUTRAL] Thank you for that. OK, and then print on, yes, uh, [PII].
[CUSTOMER][NEUTRAL] Also, can you spell out any
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Sure, and can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, it would be [PII].
[AGENT][NEUTRAL] Thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The policy number would be 2337159.
[AGENT][NEUTRAL] OK, and what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Uh, yeah, just give me a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, yeah, the member's name is [PII], and the date of birth is [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that and what was the date of service for this claim?
[CUSTOMER][NEUTRAL] It's [PII] total charge $500 even.
[AGENT][NEUTRAL] OK, that was [PII] for $500?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, one moment please.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And was that the amount before or after major medical paid?
[CUSTOMER][NEUTRAL] Uh, no, it's, uh, actually total bill amount. After amount, it would be $75 even.
[AGENT][NEUTRAL] Got it. OK. So we did receive this claim and we did pay that benefit of $75. If you give me one moment, I will get that uh claim and check information for you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, um, are you ready for the claim number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, that is 359 7.
[AGENT][NEUTRAL] 061.
[CUSTOMER][NEUTRAL] Yeah, when did you receive the claim?
[AGENT][NEUTRAL] Yes, that was received [PII].
[AGENT][NEUTRAL] And it processed on [PII].
[CUSTOMER][NEUTRAL] [PII]. OK.
[AGENT][NEUTRAL] Yes, and then I've got that uh check number whenever you're ready.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, that is 2042423.
[CUSTOMER][NEUTRAL] OK. Uh, and is it paid on the same day?
[AGENT][NEUTRAL] OK, and so
[AGENT][NEUTRAL] Yes, it was issued, uh, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, paid, uh, is it a single check?
[AGENT][NEUTRAL] Yes, single check, uh, excuse me, single check for $75.
[CUSTOMER][NEUTRAL] OK. Can you help me with the address as well?
[AGENT][NEUTRAL] Yes, so the address we have this sent to was [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] Uh, did you need a copy of this EOB or anything?
[CUSTOMER][NEUTRAL] Uh yeah, can you help me with that?
[CUSTOMER][NEUTRAL] Uh, yeah, if possible, can you, uh, send me that?
[AGENT][NEUTRAL] Yeah, did you have a fax number?
[CUSTOMER][NEUTRAL] Yeah, I do have it's uh 305.
[CUSTOMER][NEUTRAL] 6756275
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And give attention to my name [PII] last name initial [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alrighty, I'm gonna read that number back to you to make sure I heard that correctly. That was [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, that's right.
[AGENT][NEUTRAL] OK, I will go ahead and send that now. I should get it within about 10 minutes or so. Uh, did you have any other questions for me?
[CUSTOMER][NEUTRAL] Uh, not for this member, but I do have one more claim with me for another member.
[AGENT][NEUTRAL] OK, if you'll give me one moment, I'm gonna go ahead and get this sent, um, and then I'll let you know when I'm ready for that next policy number.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK thank you one moment please.
[CUSTOMER][NEUTRAL] Sure
[AGENT][POSITIVE] Alright, I appreciate your patience uh you can go ahead and give me that, uh, policy number whenever you're ready.
[CUSTOMER][NEUTRAL] Yeah, it's 02538172 M as in Mike L as in Lima number 8.
[AGENT][NEUTRAL] OK and then uh the name and date of birth for this number please?
[CUSTOMER][NEUTRAL] Yeah, the name of the member is [PII], and the date of birth is [PII].
[AGENT][POSITIVE] Perfect thank you and then what was the date of service please?
[CUSTOMER][NEUTRAL] Date of service is [PII]. Total charge $500 even.
[AGENT][NEUTRAL] OK, that was [PII] for $500?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Also, actually we did receive payment for this one.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK, let's see, was that.
[CUSTOMER][NEUTRAL] I have a concern with this claim, yeah.
[AGENT][NEUTRAL] Oh, OK, you just needing clarification. Um, was the remaining balance after major medical was that uh $399?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK awesome so I did find this claim uh yes it looks like we paid a benefit of $250 give me just a moment let me take a look there. So for this policy, um, the outpatient benefit pays on a per calendar day basis, so there is no yearly maximum, it is simply a daily maximum and that maximum amount was $250 so that did meet their maximum for this date of service.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is it on a daily basis?
[AGENT][NEUTRAL] It's, it's a daily, yes, so the outpatient benefit pays per calendar day but is $250 max per calendar day.
[AGENT][NEUTRAL] So for this member's policy that $250 met the maximum for this data service.
[CUSTOMER][POSITIVE] OK, sure, no problem. Thank you so much.
[AGENT][NEUTRAL] Yes. Sure.
[AGENT][NEUTRAL] Did you need any further information regarding this claim?
[CUSTOMER][POSITIVE] And uh thank you so much. That's it for the day. Can you help me with the call reference number?
[AGENT][NEUTRAL] Yeah, that would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII]
[CUSTOMER][POSITIVE] OK, thank you so much for your help.
[AGENT][POSITIVE] Of course, thanks for calling ATL. Have a great rest of your day.
[CUSTOMER][POSITIVE] Bye bye take care.
[AGENT][NEUTRAL] Bye-bye.