AccountId: 011433970860
ContactId: 9b9c749a-0452-4ee1-8548-86a9c621913b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 668549 ms
Total Talk Time (AGENT): 270948 ms
Total Talk Time (CUSTOMER): 170076 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/23/9b9c749a-0452-4ee1-8548-86a9c621913b_20250623T15:16_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hello [PII]. This is [PII] calling from the provider's office to check on the claim status.
[AGENT][POSITIVE] OK, [PII], I'll be glad to help you. Go ahead and give me a good policy number, please, sir.
[CUSTOMER][NEUTRAL] Sure. The member's policy number would be
[CUSTOMER][NEUTRAL] 019
[CUSTOMER][NEUTRAL] 50,960, M as in Mike, L as in Lima, number 8.
[AGENT][POSITIVE] Alrighty, [PII]. Thank you so much for that information. Now while I'm pulling this up, [PII], go ahead and give me a good return telephone card number.
[CUSTOMER][NEUTRAL] Sure. The callback number would be [PII], and that would be your direct line.
[AGENT][POSITIVE] Alrighty, [PII]. Thank you for all that information. Let's get that pulled up. Let's see.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Alright, what's your patient's name and date of birth today, please, sir?
[CUSTOMER][NEUTRAL] Sure. The patient's first name is [PII]. Last name would be [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Alrighty, thank you for that. [PII] looks like Alena is the insured on this medical supplemental plan. Now you did say you want to check status of a claim, is that correct?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] please sir.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] you know
[AGENT][NEUTRAL] Go ahead with that data service, [PII].
[CUSTOMER][NEUTRAL] Date of service is [PII] and the total charge amount would be $1950 even.
[AGENT][NEUTRAL] Alrighty, [PII]. Hold on just a moment. Let me see if I find anything. Where is that bill gonna be from? What's the provider's name, [PII]?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] All right. So you want the uh billing provider's name, right?
[AGENT][NEUTRAL] Yes, right.
[CUSTOMER][NEUTRAL] All right. So, the billing providers would be a light Imaging LLC.
[AGENT][NEUTRAL] All right, let's see.
[AGENT][NEUTRAL] Alright I do see that claim for 1950 looks like it has been processed. You will be getting a check for 279-72. Let me see when that check printed. Let's see.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Uh, this check is dated [PII], so you have not had time to get this check. It just went out last Wednesday.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] But your check's gonna be for 279-72. You want the claim number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, claim number is 3612995.
[AGENT][NEUTRAL] And you want the check number as well, [PII]? Would that help?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] That would be helpful.
[AGENT][NEUTRAL] Check number is 2, 20499007.
[CUSTOMER][NEUTRAL] 7. All right. Uh if you could you just help me with the received date and the process date for this one?
[AGENT][NEUTRAL] I sure will. Hang on a minute, [PII].
[AGENT][NEUTRAL] Alright. Receive date is [PII]. Pay date, of course, is check date [PII].
[AGENT][NEUTRAL] Is there anything else I can help you with, [PII]?
[CUSTOMER][NEUTRAL] Uh, no, just, uh, as you stated that the claim is paid, right? And the what would be the allowed amount of the, is it a single check or bulk check?
[AGENT][NEUTRAL] It's the same
[CUSTOMER][NEUTRAL] you want
[AGENT][NEUTRAL] I will check for 27972. We are the medical supplemental plan.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] All right then. [PII], I do have one more member, so could you just help me with that as well?
[AGENT][NEUTRAL] Yeah, is it on a different patient?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh, yes, different patients.
[AGENT][NEUTRAL] OK, well, hang on just a second. Let me get out of this and you just have one more. Is that correct, [PII]?
[CUSTOMER][NEUTRAL] Yes, and that will be under the same uh billing provider.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Alright, hang on just a second, OK?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] No worries, take your time.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, well let's go ahead with that other policy number.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Go ahead with that policy number, [PII], yeah.
[CUSTOMER][NEUTRAL] All right, [PII], uh,
[CUSTOMER][NEUTRAL] Sure. The next member's policy number would be 02473409 M as in Mike L as in Lima H.
[AGENT][NEUTRAL] Alrighty, well send your patient's name and date of birth.
[CUSTOMER][NEUTRAL] Sure. The patient's first name is [PII]. Last name would be [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Uh looks like she is the insured on this medical supplemental plan and you want.
[AGENT][NEUTRAL] Check status of a claim. What's that date of service?
[CUSTOMER][NEUTRAL] Uh, date of service is [PII].
[CUSTOMER][NEUTRAL] And the total bill amount is $1,88058 even for this one.
[AGENT][NEUTRAL] Alright, let's see.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] To uh.
[AGENT][NEUTRAL] Yeah, looks like that is, that claim has been paid as well, [PII]. Looks like a check for $300 just printed on [PII]. You have not had time to get this check yet?
[AGENT][NEUTRAL] Let me see, your claim number is going to be 361.
[AGENT][NEUTRAL] 4
[AGENT][NEUTRAL] 4988.
[CUSTOMER][NEUTRAL] Uh, could you just repeat that one more time?
[AGENT][NEUTRAL] Your check number is
[AGENT][NEUTRAL] Sure, 361-498-8.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] And your check number is 2051073.
[CUSTOMER][NEUTRAL] All right. And the check date which you mentioned is [PII].
[AGENT][NEUTRAL] [PII]. Mhm. Correct.
[CUSTOMER][NEUTRAL] All right. And let me for this one, could you just help me with the allowed amount and is there any patient responsibility or something like that?
[AGENT][NEUTRAL] Uh, the allowed amount is 44113. We, uh, the max benefit here is $300. Patient will owe difference.
[CUSTOMER][NEUTRAL] Sorry, the, the maximum allowed amount would be, uh, maximum pay is $300 right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And the remaining amount that will be $141.13. What would be that? Would it be the the adjustment or?
[AGENT][NEUTRAL] That would be up to the provider. I can just tell you what we pay.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] I said that that is up to the provider. It depends on if this provider is in the PPO network with the patient's primary insurance, so I would not be able to answer that particular question. I can just tell you what our benefit is and it's $300.
[CUSTOMER][NEUTRAL] But.
[CUSTOMER][NEUTRAL] Yeah. Alright.
[AGENT][NEUTRAL] And do you want receive date?
[CUSTOMER][NEUTRAL] Yes, so I
[AGENT][NEUTRAL] Received date is gonna be [PII] and of course it was paid on [PII] check date.
[CUSTOMER][NEUTRAL] All right then. Thank you for that, [PII]. And lastly, could you just help me with the call reference number?
[AGENT][POSITIVE] Oh you're welcome.
[AGENT][NEUTRAL] Well, [PII], we don't give call reference numbers, but you can use my name in today's date and my name is [PII] and that is spelled [PII]
[CUSTOMER][POSITIVE] All right, lovely. Thank you for that. And hope you have a great day. Bye for now.
[AGENT][POSITIVE] You're welcome. You as well. You're so welcome, and thanks, [PII] for calling APL. Have a great day.
[CUSTOMER][POSITIVE] You too have a great day.
[AGENT][NEUTRAL] You too, bye bye.