AccountId: 011433970860
ContactId: 94fcc206-bdd9-494e-9b3c-3b802e4df87a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 656039 ms
Total Talk Time (AGENT): 140545 ms
Total Talk Time (CUSTOMER): 334825 ms
Interruptions: 4
Overall Sentiment: AGENT=0, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/94fcc206-bdd9-494e-9b3c-3b802e4df87a_20250421T19:39_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling for the provider to check on the claim status. Please be informed that this call is being recorded and monitored for quality and training purposes. So, may I know how can I help you with the patient's information or the provider's information?
[AGENT][NEUTRAL] Uh, yes, I can help you with claim status, [PII]. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII]. No extension it's a direct line.
[AGENT][NEUTRAL] And the policy number of the patient?
[CUSTOMER][NEUTRAL] Yeah, the patient's policy number is 01835977.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient's first name is [PII] and the last name is [PII], and the date of birth will be [PII].
[AGENT][NEUTRAL] And date of service and build them out?
[CUSTOMER][NEUTRAL] Date of service will be [PII] and the bill amount will be $1,764 even.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, looks like we received it a few times. Let me see which uh claim is correct.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, looks like we received that on 225-25.
[AGENT][NEUTRAL] Made a payment on the same day.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] 107,430.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I mean.
[CUSTOMER][NEUTRAL] OK, you guys received the claim and paid on the same day.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And the process date will be the same?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, could you please tell me the, what is the paid amount?
[AGENT][NEUTRAL] 107,430.
[CUSTOMER][NEUTRAL] Uh, sorry, your voice is breaking. Could you please repeat once again?
[AGENT][NEUTRAL] 107,430.
[CUSTOMER][NEUTRAL] 1,074 and 30 cents. Am I right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and what is the allowed amount?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] This is a secondary supplemental policy, so there's not an allowed amount. That's, that's the amount we paid.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. And could you please tell me how was the payment done via check or EFT?
[AGENT][NEUTRAL] It was by a check, single check 202, check number 2029591.
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Oh you're.
[CUSTOMER][NEUTRAL] Could you please help me with the claim number?
[AGENT][NEUTRAL] My number 356-7855.
[CUSTOMER][NEUTRAL] The.
[CUSTOMER][NEUTRAL] 3567855. Am I right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and could you please tell me
[CUSTOMER][NEUTRAL] So the allowed amount and the paid amount is the same. So, uh so there is no patient responsibility. Am I right?
[AGENT][NEUTRAL] I all I can do is tell you what the claim paid. We don't determine patient responsibility.
[CUSTOMER][NEUTRAL] OK, you don't determine patient's responsibility. OK.
[CUSTOMER][NEUTRAL] And what was the reason you send me for the other? Could you please uh repeat the reason once again because I want to note it.
[AGENT][NEUTRAL] We, we this is a secondary policy so we pay up according to how the policy pays out. We don't determine patient responsibility or what's allowed we just pay according to what the plan covers.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. So you guys don't have the allowed amount and the paid amount, uh, allowed amount and the member's responsibility.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Check number 10. OK. Could you please help me with, uh, could you please verify me the payment's mailing address?
[AGENT][NEUTRAL] Um, yes, give me one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh mailing address [PII].
[CUSTOMER][POSITIVE] I like.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Check issue date was [PII]. Check cleared [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, so, [PII], uh, this is, uh, the claim status which you're giving me. This is for the uh [PII], am I right?
[AGENT][NEUTRAL] For
[AGENT][NEUTRAL] Are you asking what the patient name is?
[CUSTOMER][NEUTRAL] Yeah, the patient's name is [PII]. Am I right?
[AGENT][POSITIVE] Yes, you gave me the patient name, [PII]. Correct.
[CUSTOMER][NEUTRAL] And the date of service is [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, could you please verify me the patient's account number?
[AGENT][NEUTRAL] Patients what?
[CUSTOMER][NEUTRAL] Patient's account number.
[CUSTOMER][NEUTRAL] V as in Victor number.
[CUSTOMER][NEUTRAL] Uh, it can.
[AGENT][NEUTRAL] You have the number? What number do you have?
[CUSTOMER][NEUTRAL] Uh yeah. Uh, should I verify from my end?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, it's 1334135 V as in Victor 15058.
[AGENT][NEUTRAL] I've got 1335841.
[AGENT][NEUTRAL] V as in Victor, 15058.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, could you please repeat?
[AGENT][NEUTRAL] 1335841 V as in Victor 15058.
[CUSTOMER][NEUTRAL] There's a.
[CUSTOMER][NEUTRAL] OK, so that's the not the patient's number matching to my patient number.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Give me a minute.
[CUSTOMER][NEUTRAL] Uh, so [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Are you there?
[CUSTOMER][POSITIVE] Thanks.
[AGENT][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] Uh, you're not valuable to me. Uh, yeah, definitely, I do have one claim number with me, uh, because, uh, one of our representatives, they have called you guys on [PII] and
[CUSTOMER][NEUTRAL] Spoke with one of your representative. Her name is [PII], and she told that the claim is in process. So I do have one claim number with me. Could you please check, check with that claim number?
[AGENT][NEUTRAL] What is it?
[CUSTOMER][NEUTRAL] It's 351-071-4.
[AGENT][NEUTRAL] Yeah, this is the same claim.
[AGENT][NEUTRAL] Of the information I just gave you, so it looks like it was submitted twice.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] That claim that you just gave me.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It didn't process so it processed under the claim number I gave you.
[AGENT][NEUTRAL] So what are, what questions?
[CUSTOMER][NEUTRAL] OK, so the claim was submitted twice.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Could you please give me information of status regarding my claim number and the patient account number which I gave you?
[AGENT][NEUTRAL] I'm sorry, what?
[CUSTOMER][NEUTRAL] Could you please give me status regarding my uh the patient number patient account number which I gave you and the claim number which I gave you right now. Do you have any status regarding uh this claim?
[AGENT][NEUTRAL] OK
[AGENT][NEGATIVE] No, it wasn't processed.
[AGENT][NEGATIVE] No, it was not processed.
[CUSTOMER][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] Mm OK. Why is, why was not processed?
[AGENT][NEUTRAL] It was processed under the number that I gave you 356-785-5.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. But the account num uh the patient's account number is different.
[AGENT][NEUTRAL] I'm pulling up what we received. Is this a facility charge?
[AGENT][NEUTRAL] This is a hospital charge?