AccountId: 011433970860
ContactId: 9b2acd5e-4757-4acc-8603-629daa271f87
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 641090 ms
Total Talk Time (AGENT): 174841 ms
Total Talk Time (CUSTOMER): 192772 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/9b2acd5e-4757-4acc-8603-629daa271f87_20250619T14:35_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello, calling from the provider's office to check medical claim status.
[AGENT][NEUTRAL] OK, I can check on a claim for you. What was your name please?
[CUSTOMER][NEUTRAL] My name is [PII]
[AGENT][NEUTRAL] OK, and then [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it is [PII]. Direct line, no [PII].
[AGENT][NEUTRAL] Thank you. Do you have that policy number?
[CUSTOMER][NEUTRAL] Yes, just a minute.
[CUSTOMER][NEUTRAL] Um, the policy number is 02444783.
[AGENT][NEUTRAL] OK, and what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Member's name is [PII].
[CUSTOMER][NEUTRAL] Ticket, ticket and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. What was the date of service for this claim?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It is 320
[AGENT][NEUTRAL] OK, and then that bill them out please.
[CUSTOMER][NEUTRAL] $21,487 even.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], do you have that amount that uh was left over after major medical paid?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Hm, yes, it is.
[CUSTOMER][NEUTRAL] 203999.18.
[AGENT][NEUTRAL] That was what was.
[AGENT][NEUTRAL] I made your call or that was what was left over.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Well.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so I did find this correct claim. I apologize it looks like we had a few um duplicates, so we did pay a benefit of $1,087.82 for this claim. Uh, whenever you're ready I can give you that claim number and that check information.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEUTRAL] They
[AGENT][NEUTRAL] Are you still there [PII]?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Hello, [PII], can you hear me?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] and
[AGENT][NEUTRAL] Can you hear me?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yes, I can hear you.
[AGENT][NEUTRAL] OK, I did find that claim. We did pay a benefit of $1,087.82. I have that claim and check information for you when you're ready.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, just a minute. Uh, when was the claim received?
[AGENT][NEUTRAL] Uh, one moment, let me get that.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] This claim was received [PII], and it was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. What was the allowed amount?
[AGENT][NEUTRAL] We did pay a benefit of $1,087. Uh, 0, give me just a moment, let me get back to that.
[CUSTOMER][NEUTRAL] No you did you do?
[AGENT][NEUTRAL] $1,087.82.
[CUSTOMER][NEUTRAL] OK. So the allowed amount is all the same?
[CUSTOMER][NEUTRAL] So.
[AGENT][POSITIVE] Yes, that met their maximum.
[CUSTOMER][NEUTRAL] OK. So there is no member responsibility?
[AGENT][NEUTRAL] We don't say what is patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] OK, um, are there any denied charges or non-car charges?
[AGENT][NEUTRAL] Uh, one moment, let me get that.
[AGENT][NEUTRAL] So the bill amount that we received was uh $3,219 for this, but this payment that we made uh met their benefit maximum.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] So maximum benefits have been met.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, just a minute.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] but the
[CUSTOMER][NEUTRAL] Mm, OK. May I know maximum benefits in terms of dollar or visits?
[AGENT][NEUTRAL] Yes, it was the dollar amount, um, so their maximum benefits per calendar year for outpatient services is $3000.
[AGENT][NEUTRAL] And that with this payment it met that maximum.
[CUSTOMER][NEUTRAL] 3000.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so the dollar amount is $3000.
[AGENT][NEUTRAL] Per calendar year correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. In this dollar amount, how much did the patient make?
[AGENT][NEUTRAL] This payment, the $1,087.82 met that $3000 maximum.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] 87.80. 1087.80, right?
[AGENT][NEUTRAL] 0.82.
[CUSTOMER][NEUTRAL] I'm.
[CUSTOMER][NEUTRAL] 082. OK. So, hm.
[CUSTOMER][NEUTRAL] Uh, so, patients have not met the total dollar amount, right?
[AGENT][NEUTRAL] They did with this payment, this benefit met that $3000 maximum.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] The maximum amount is allowed amount is 3000 and the patient met is 1087.82.
[AGENT][NEUTRAL] With this payment, yes, we had paid prior claims to this claim. This was the one that met that 3000.
[CUSTOMER][NEUTRAL] Right?
[CUSTOMER][NEUTRAL] Mhm. Mm. So, can you send the claim back for the reprocess?
[AGENT][NEUTRAL] They met the maximum that's this is the maximum amount payable.
[CUSTOMER][NEUTRAL] Mm. OK.
[CUSTOMER][NEUTRAL] OK, just a minute.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] OK, can you fax me the COB?
[AGENT][NEUTRAL] Of course, what was that fax number for you?
[CUSTOMER][NEUTRAL] 866
[CUSTOMER][NEUTRAL] 463
[CUSTOMER][NEUTRAL] 7453.
[AGENT][NEUTRAL] OK, I'm gonna read that back to make sure I heard that correctly. That was [PII]?
[CUSTOMER][NEUTRAL] Yes, right.
[AGENT][NEUTRAL] OK, uh, I will send that now. I should get it within about 10 minutes or so.
[CUSTOMER][NEUTRAL] OK. Thank you. Can I get the call reference?
[AGENT][NEUTRAL] Sure, was there anything else I could help you with?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII] last initial is [PII]
[CUSTOMER][NEUTRAL] Yeah, call reference.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] OK. Thank you so much for the valuable information you provided me today. Have a wonderful day.
[AGENT][POSITIVE] Thanks for calling APL you too bye bye.