AccountId: 011433970860
ContactId: 9ac74dcf-845c-4d06-8e53-e9da732de296
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 300239 ms
Total Talk Time (AGENT): 101360 ms
Total Talk Time (CUSTOMER): 64098 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/9ac74dcf-845c-4d06-8e53-e9da732de296_20250114T15:34_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII]. I would like to know the claim status.
[AGENT][NEUTRAL] For I can assist you today. Can I have a callback number for you and that policy number?
[CUSTOMER][NEUTRAL] That's [PII]. The member ID?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEGATIVE] I'm sorry, your voice is cutting you now.
[AGENT][POSITIVE] Yes, that is correct. That will be the policy number.
[CUSTOMER][NEUTRAL] That's 2546457.
[AGENT][NEUTRAL] Could you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient was [PII], date of birth [PII].
[AGENT][NEUTRAL] Thank you [PII], and you're calling to check the status of a claim for what date of service?
[CUSTOMER][NEUTRAL] Mhm. I would like to reclaim status, the date of service. That's [PII].
[AGENT][NEUTRAL] There was a payment of $370 made on this claim. Would you like the check number?
[CUSTOMER][NEUTRAL] Uh, just allow me a second.
[CUSTOMER][NEUTRAL] Um, how much insurance pay?
[AGENT][NEUTRAL] $370 370.
[CUSTOMER][NEUTRAL] OK. What's the check number?
[AGENT][NEUTRAL] 2021604. It's 2021604.
[CUSTOMER][NEUTRAL] You shouldn't clear date?
[AGENT][NEUTRAL] This claim was sent out. The payment was made on [PII].
[CUSTOMER][NEUTRAL] Uh, OK. I'm sorry, your voice is cutting in now. Can you please fix your mic?
[AGENT][NEUTRAL] The claim was paid July on [PII].
[CUSTOMER][NEUTRAL] [PII], and clear date?
[AGENT][NEUTRAL] There is no clear date. It may not have arrived in the mail yet. It's just the [PII]. If it was processed on the [PII], which was a Tuesday, it probably went out on a Wednesday or Thursday.
[CUSTOMER][NEUTRAL] OK, so you mean to say uh the payment uh made $370. The check was not sent yet.
[AGENT][NEGATIVE] No, I've been stated, I stated that the check was, there was a payment of $370. The claim was processed on the [PII]. However, um, the payment have not may have not been mailed out until the [PII] or the [PII], of which was a Wednesday or the [PII], which was a Thursday. However, today is the [PII]. It has not been 5 business days.
[CUSTOMER][NEUTRAL] OK. What's, uh, how much is the patient responsibility?
[AGENT][NEUTRAL] Bear with me while the ELB pulls up.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Patient responsibility is 439.
[CUSTOMER][NEUTRAL] Patient responsibility for $39. What's the claim number?
[AGENT][NEUTRAL] 3543645
[CUSTOMER][NEUTRAL] OK. Can you tell me how, um, is there any denial under this claim?
[AGENT][NEUTRAL] So for procedure code.
[AGENT][NEUTRAL] D 0230, the payment went towards the deductible.
[AGENT][NEUTRAL] So the patient only owes $69.
[AGENT][NEUTRAL] The patient, the original amount was $439. We paid $370 and the patient responsibility is $69.