AccountId: 011433970860
ContactId: 97a622c7-c704-4397-9db8-c26f58f0572f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 373850 ms
Total Talk Time (AGENT): 147478 ms
Total Talk Time (CUSTOMER): 62441 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/97a622c7-c704-4397-9db8-c26f58f0572f_20250328T18:12_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from provider's office to check on the claim status.
[AGENT][NEUTRAL] OK, did you say that your name is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, [PII], yes, and you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes ma'am, I can help you with that and what is your callback number please?
[CUSTOMER][NEUTRAL] The callback number is [PII].
[AGENT][NEUTRAL] Thank you. And how many claims, ma'am, do you have to check status on today?
[CUSTOMER][NEUTRAL] One
[AGENT][NEUTRAL] OK, and what is that member's policy number please?
[CUSTOMER][NEUTRAL] Uh, it is 023 05575.
[AGENT][NEUTRAL] OK thank you one moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Uh, name of the patient is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] One moment, please.
[AGENT][NEUTRAL] OK, and what is the date of service and total bill amount for her place?
[CUSTOMER][NEUTRAL] It is [PII] and the total charge amount is $2520 even.
[AGENT][NEUTRAL] And again you said the data service is [PII], is that correct?
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so this claim was received. It was received on 11-27-2023?
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] The claim number is 3,389,030.
[AGENT][NEUTRAL] There was a benefit paid in the amount of $50.
[AGENT][NEUTRAL] And that was paid on check number 182.
[AGENT][NEUTRAL] 3643 and that check has did clear. 12-1120 23.
[AGENT][NEUTRAL] And the remark on this code for this claim rather Sam states with this check the maximum benefit payable for this state of service has been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, may I know maximum benefit exhausted for the CPT code? And is there any particular CPT code?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Again, for this particular type of plan, this is a hospital indemnity limited benefit plan that pays specific dollar amounts for certain services, and the $50 was the maximum benefit payable for this state of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And may I know the paid amount once again?
[AGENT][NEUTRAL] $50.
[CUSTOMER][NEUTRAL] 60, right?
[AGENT][NEUTRAL] 50.
[CUSTOMER][NEUTRAL] All right, um, so if this is a single payment or bulk payment?
[AGENT][NEUTRAL] I'm sorry, what was your question?
[CUSTOMER][NEUTRAL] Uh, no, is it a single payment or bulk payment?
[AGENT][NEUTRAL] Yes, ma'am. I, I explained that it was a single check.
[AGENT][NEUTRAL] And I gave you the check number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And may I know the call reference number?
[AGENT][NEUTRAL] Yes ma'am, and if you need a copy of this explanation of benefits, [PII], you should be able to print out directly from our portal and do you already have our portal website, the secured. [PII]?
[CUSTOMER][NEUTRAL] Yes, sure.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK, and the reference number that you would use for our call today would be my name along with today's date.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] OK. Well, can I help you with anything else?
[CUSTOMER][POSITIVE] No, thank you so much for assisting. Have a great day.
[AGENT][POSITIVE] Well, you're very welcome, [PII] and thank you for calling APL. I hope you have a wonderful weekend.
[CUSTOMER][POSITIVE] Yeah. Thank you so much.
[AGENT][POSITIVE] Uh-huh. You're welcome. Bye-bye.