AccountId: 011433970860
ContactId: a2b95871-3043-48be-8bc2-e5c7f7049e16
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 350980 ms
Total Talk Time (AGENT): 158008 ms
Total Talk Time (CUSTOMER): 105176 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/a2b95871-3043-48be-8bc2-e5c7f7049e16_20250204T15:42_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is I'm calling from provider's office to check the claim status.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, I can check on a claim for you. Um, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]. It's a direct line?
[AGENT][NEUTRAL] OK, I'm sorry, it kind of cut out there. Could you repeat that?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you, and then, uh, did you have the policy number?
[CUSTOMER][NEUTRAL] Yes, policy number is.
[CUSTOMER][NEUTRAL] 01869443 M as in Mary, L as in Lima, number 8.
[AGENT][NEUTRAL] And then uh the name and date of birth for the insured, please?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Alright, thank you for verifying that and what was the date of service for this claim, please?
[CUSTOMER][NEUTRAL] Date of service is [PII].
[AGENT][NEUTRAL] OK, and the uh billed out?
[CUSTOMER][NEUTRAL] The amount is 1 2nd.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] $10,415 even.
[AGENT][NEUTRAL] OK thank you one moment please.
[CUSTOMER][NEUTRAL] So it's a follow-up call. Previously, they requested for primary OB. We have already sent it. Can you just verify if you have received it?
[AGENT][NEUTRAL] You did, OK.
[AGENT][NEUTRAL] Sure, give me just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And [PII], do you happen to have the remaining balance after major medical paid?
[CUSTOMER][NEUTRAL] No, I don't have that balance. The balance would be
[CUSTOMER][NEUTRAL] I'm not sure, but it's showing me $1,668 even.
[AGENT][POSITIVE] OK, OK, perfect, thank you for verifying that alrighty so we did receive that and looks like we did receive that um explanation of benefits.
[AGENT][NEUTRAL] So for this claim we paid a benefit of $393.49 and that did meet their maximum amount payable for the date of service.
[CUSTOMER][NEUTRAL] OK. What is the allowed amount?
[AGENT][NEUTRAL] Uh, give me just a moment, let me get that.
[CUSTOMER][NEUTRAL] I have some
[AGENT][NEUTRAL] OK, uh, so their outpatient benefit it was on a per calendar day basis, so it paid $1000 max per calendar day, uh, so this insurer did have other claims for that date of service that had paid additional prior to this, so that $393.49 was the remaining amount that we could pay.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. So, do you have the allowed amount?
[AGENT][NEUTRAL] The total allowed amount was $1000 per calendar day.
[CUSTOMER][NEUTRAL] $1000. All right. So is it paid through check or EFT?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was a check um I can get that. Did you want that claim number first?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, that claim number is 55.
[AGENT][NEUTRAL] 55
[AGENT][NEUTRAL] 686.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then I've got that check number as well whenever you're ready, yes, um, so that check number is.
[CUSTOMER][NEUTRAL] And the check number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] 2024.
[AGENT][NEUTRAL] 411.
[CUSTOMER][NEUTRAL] What is the check date?
[AGENT][NEUTRAL] I've got that issue date as [PII].
[AGENT][NEUTRAL] And I am showing that it cleared.
[AGENT][NEUTRAL] On [PII] as well.
[CUSTOMER][NEUTRAL] OK, so is it a single amount or bulk amount?
[AGENT][NEUTRAL] It was a single check.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And also can you please fax me the pay DOB?
[AGENT][NEUTRAL] Of course, what was that fax number for you?
[CUSTOMER][NEUTRAL] Fax number is 866.
[CUSTOMER][NEUTRAL] 463-745-3
[AGENT][NEUTRAL] OK, I'm going to read that back to you so make sure I heard that correctly. That was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'm gonna just put this to your attention, [PII]?
[CUSTOMER][NEUTRAL] Attention to my name, sir.
[AGENT][NEUTRAL] OK, alrighty, I'll go ahead and get that sent to you now. Uh, you should get it here in maybe 10-15 minutes depending on how busy your machine is. Did you have any other questions for me?
[CUSTOMER][NEUTRAL] Can I get the call reference number?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date, um, so my name is spelled [PII] last [PII]
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] All right. Thank you. Thank you so much for that information. Have a great day.
[AGENT][POSITIVE] Of course, yeah, thanks for calling ATL. You too, bye bye.
[CUSTOMER][NEUTRAL] Bye bye.