AccountId: 011433970860
ContactId: aaa97def-0dbb-4f1e-b1d7-b23b8529fc25
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 463339 ms
Total Talk Time (AGENT): 112890 ms
Total Talk Time (CUSTOMER): 132499 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/aaa97def-0dbb-4f1e-b1d7-b23b8529fc25_20250306T18:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APR. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from the provider office. Uh,
[CUSTOMER][NEUTRAL] Just want to know the claim status.
[AGENT][NEUTRAL] I'm sure I can assist you with claim status. First, can I get your name again and a good callback number?
[CUSTOMER][NEUTRAL] Yes, my name is [PII].
[AGENT][NEUTRAL] Thank you, 0. Now, could I get the policy number, please?
[CUSTOMER][NEUTRAL] Yes, policy number is 02049543.
[AGENT][NEUTRAL] OK, and I'm sorry, please verify your callback number.
[CUSTOMER][NEUTRAL] [PII]. My extension is [PII].
[AGENT][NEUTRAL] OK, got it. Thank you. And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yes, give me a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Patient name is [PII].
[CUSTOMER][NEUTRAL] [PII] and the date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. Now I need the date of service and bill charges on the claim.
[CUSTOMER][NEUTRAL] Data service [PII]. And the charge amount is
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] $36369.25.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm not showing that claim on file. Um, how was it submitted?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] It was submitted.
[CUSTOMER][NEUTRAL] Like wire print.
[CUSTOMER][NEUTRAL] Because.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, I'm not showing the claim on file, but it can be resubmitted.
[CUSTOMER][NEUTRAL] But previously, we spoke with the rep and she stated it was claim it, the claim was on file and it was paid as a deductible, paid through the deductibles. But the claim like
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, did she give
[AGENT][NEUTRAL] Did she give you a claim number?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, what's that claim number?
[CUSTOMER][NEUTRAL] Yes. It's 3.
[CUSTOMER][NEUTRAL] Yes, it's 355-89552.
[AGENT][NEUTRAL] OK, one moment, please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK. Yes, sir. I am showing that claim on file and the charged amount is different. Um, but yes, I am showing that um it went towards the $500 deductible. There's a $500 deductible on this policy, and that's where the benefits went.
[CUSTOMER][NEUTRAL] OK. Uh, may I know when, when you received the claim?
[AGENT][NEUTRAL] Yes, we received the claim on.
[AGENT][NEUTRAL] We received the claim on [PII] and it processed on [PII].
[CUSTOMER][NEUTRAL] [PII] and [PII], it was processed.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, through the deductible?
[AGENT][NEUTRAL] Please repeat the question.
[CUSTOMER][NEUTRAL] Uh, it was paid as a deductible?
[AGENT][NEUTRAL] Yes, the um payment went towards the policy's deductible.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. May I know the, what was the
[CUSTOMER][NEUTRAL] Annual deductible
[AGENT][NEUTRAL] The annual deductible, yes, it's $500.
[CUSTOMER][NEUTRAL] Of the member?
[CUSTOMER][NEUTRAL] $500.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And how much amount it was met?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] $255.83.
[CUSTOMER][NEUTRAL] $255.83.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Give me a moment.
[CUSTOMER][NEUTRAL] Just give me a moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK. Do you have a UB regarding on this claim?
[AGENT][NEUTRAL] Yes, there is an ELB.
[CUSTOMER][NEUTRAL] Yes. So can you fax it?
[AGENT][NEUTRAL] Yes, what's your fax number, please?
[CUSTOMER][NEUTRAL] Yes. Fax number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so that's attention [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, one moment, please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK. I just faxed the EOB. You should receive it in about 10 minutes. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] No. May I know your name?
[AGENT][NEUTRAL] My name is [PII]. It's spelled [PII] and my last initial is [PII].
[CUSTOMER][NEUTRAL] OK. [PII], uh, may I know the call reference number?
[AGENT][NEUTRAL] The call reference number is my name and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you for the information.
[AGENT][POSITIVE] OK, thank you for calling APL. You have a great day. Mm bye.
[CUSTOMER][NEUTRAL] You too.