AccountId: 011433970860
ContactId: 9d54f825-699e-494b-a261-e4ae850679ff
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 469140 ms
Total Talk Time (AGENT): 157001 ms
Total Talk Time (CUSTOMER): 100366 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/9d54f825-699e-494b-a261-e4ae850679ff_20250506T20:43_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] This is [PII] calling from provider's office to check up on a claim status. How are you doing today?
[AGENT][POSITIVE] I'm doing well. How are you?
[CUSTOMER][POSITIVE] Yeah, I'm doing great as well. Thanks for asking.
[AGENT][POSITIVE] That's good, and I'll be more than happy to assist you with your claim status, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. It is [PII]. It's a direct line, no extension.
[AGENT][NEUTRAL] Thank you. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Just one only.
[AGENT][NEUTRAL] OK, may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. The member's policy number is 0197.
[CUSTOMER][NEUTRAL] 989
[CUSTOMER][NEUTRAL] 3 M as in Mike. L as in Lima 7.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Number's first name is [PII] and the last name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claim you like me to check on?
[CUSTOMER][NEUTRAL] date of service is [PII]. Total bill amount for this one will be
[CUSTOMER][NEUTRAL] $14,368 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] In just a second.
[CUSTOMER][NEUTRAL] It's a Florida Mercy Hospital.
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 353-0245.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] [PII], it was denied, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Of [PII] of last year, right?
[AGENT][POSITIVE] Yes, that's correct. And it looks like um
[AGENT][NEUTRAL] Looks like we received the um the explanation of benefits and we paid out $500 to the provider for the emergency room, um.
[AGENT][NEUTRAL] We received the correct claim on April.
[CUSTOMER][NEUTRAL] What is the allowed?
[AGENT][NEUTRAL] Did you need the additional information for the corrected claim?
[CUSTOMER][NEUTRAL] No, I'm just asking like what is the allowed amount and the paid amount for this?
[AGENT][NEUTRAL] The allowed amount is $500.
[CUSTOMER][NEUTRAL] It's the same as the paid amount, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. There is no patient responsibility?
[AGENT][NEUTRAL] No, we don't determine patient responsibility. Um, so it would be whatever your policy is for remaining or outstanding balances.
[CUSTOMER][NEUTRAL] OK. And the payment was made by check or EFT?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] The claim was received back on [PII], right?
[AGENT][NEUTRAL] Well, that's what I was asking. I was trying to give you the correct claim information on the date that it was received and processed, the November date is the original claim.
[AGENT][NEUTRAL] Um, did you still need the check information?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so it was a single check?
[AGENT][NEUTRAL] Check number 2041988.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] It was issued on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] In the amount of $500?
[AGENT][NEUTRAL] It was mailed to [PII]. Is that the correct address?
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] Could you please repeat that address once again?
[AGENT][NEUTRAL] Sure, [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, no issues.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The reason I'm asking is because the check is still showing as outstanding. Um, so if you have not, if you do not receive the check by [PII], you can give us a call and we can check on the check and reissue if needed.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. It was just uh released recently only.
[AGENT][NEUTRAL] It was issued on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, uh, so it is just been released recently and no issue with that.
[AGENT][POSITIVE] All right, was there anything else I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] But just hold on for a moment.
[CUSTOMER][NEUTRAL] Claim number is 3530245, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] May I have the call reference number?
[AGENT][NEUTRAL] So there's no call reference number. You can use my name and today's date.
[CUSTOMER][NEUTRAL] Could you please spell out your name?
[AGENT][NEUTRAL] My name is [PII] The first initial [PII] my last name is [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much for the assistance, [PII].
[CUSTOMER][POSITIVE] Have a wonderful rest of the day. Bye for now.
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] No, that's it for this call.
[AGENT][POSITIVE] Alright, thanks for calling APL. I hope you have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Yeah