AccountId: 011433970860
ContactId: b3950b9a-2cc8-404b-8d8a-5b95f438cadf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 458149 ms
Total Talk Time (AGENT): 203493 ms
Total Talk Time (CUSTOMER): 134384 ms
Interruptions: 1
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/b3950b9a-2cc8-404b-8d8a-5b95f438cadf_20250306T18:19_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. Can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider's office. Could you please assist me with the claim status?
[AGENT][NEUTRAL] Sure, I can verify claim status for you. And you say your name is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I can verify claim status for you, [PII], and what is that policy number, please?
[CUSTOMER][NEUTRAL] 1905619
[AGENT][NEUTRAL] OK, thank you. Give me one moment. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Callback number is [PII].
[AGENT][NEUTRAL] OK, and the patient's name, date of birth?
[CUSTOMER][NEUTRAL] His name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] [PII]. The bill amount is $629.
[AGENT][NEUTRAL] OK, thank you. And do you have the balance after primary insurance has processed the claim?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and that amount is?
[CUSTOMER][NEUTRAL] You want the balance amount or the bill amount?
[AGENT][NEUTRAL] Uh, want the balance after primary insurance has processed the claim?
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] The bill amount is $639 even.
[AGENT][NEUTRAL] You gave me that amount. I'm asking the balance after primary insurance has processed the claim.
[CUSTOMER][NEUTRAL] The balance is $50 even.
[AGENT][NEUTRAL] OK. Thank you. Give me one moment. And [PII], while I'm looking up claim information, just to let you know we do have an online service center where providers can check claim status as well as print out the EOB. That site is at [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I apologize, you're calling from again?
[CUSTOMER][NEUTRAL] Calling from Express Wellness urgent Care.
[AGENT][NEUTRAL] OK, I'm showing that claim process as the outpatient benefits of maxed for the calendar year.
[CUSTOMER][NEUTRAL] You know
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK. May I know previously when it was built?
[AGENT][NEUTRAL] No, this is the first time we received this claim, but the claim process has the benefits of Max for the calendar year.
[CUSTOMER][NEUTRAL] Uh, that's what I'm asking. Uh, it's counter has been previously paid, right? This is the first service we can build.
[CUSTOMER][NEUTRAL] So that's why I'm asking.
[AGENT][NEUTRAL] I'm not understanding what you're asking because
[AGENT][NEUTRAL] It's a total max per calendar year for outpatient and they've already met their benefits, not from a claim from y'all received twice, but there was other providers, but I cannot give you any information on when the claim maxes benefits.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Uh, that's why now.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] One second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Could you please spell your name?
[AGENT][NEUTRAL] Sure, it's [PII].
[CUSTOMER][NEUTRAL] OK, wait for the next members ID.
[AGENT][NEUTRAL] I'm sorry, say again.
[CUSTOMER][NEUTRAL] May I buy the next member's ID?
[AGENT][NEUTRAL] I'm sorry, say that one more time.
[CUSTOMER][NEUTRAL] I have another one more patient. May you provide the ID number?
[AGENT][NEUTRAL] OK, for so it's a different patient than [PII], correct? OK, give me one moment, please.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and what is the next policy number, please?
[CUSTOMER][NEUTRAL] OK. The policy number is 021.
[CUSTOMER][NEUTRAL] 562
[CUSTOMER][NEUTRAL] 45
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] [PII], the charge amount is $167 even.
[AGENT][NEUTRAL] OK. And do you have to have the balance after that uh after primary process this claim?
[CUSTOMER][NEUTRAL] $50 even.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK. And this is for the same provider, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, uh, showing this claim paid the $50 and this was processed on [PII].
[CUSTOMER][NEUTRAL] OK, when [PII].
[CUSTOMER][NEUTRAL] OK. May I know when was the claim received?
[AGENT][NEUTRAL] Uh, the claim was initially received [PII].
[CUSTOMER][NEUTRAL] Can I know the mode of payment?
[AGENT][NEUTRAL] Uh it was sent a paper check.
[CUSTOMER][NEUTRAL] Ah, made the.
[CUSTOMER][NEUTRAL] Uh, the check number?
[AGENT][NEUTRAL] 2018568.
[CUSTOMER][NEUTRAL] Single check or bulk check?
[AGENT][NEUTRAL] Single
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm and uh.
[CUSTOMER][NEUTRAL] May I know the address it was paid?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] May I know when was it issued and cleared?
[AGENT][NEUTRAL] I don't show it. It's clear, but I do show it was issued [PII].
[CUSTOMER][NEUTRAL] OK, still not cash it's almost 3 months. So could you please read the check?
[AGENT][NEUTRAL] Uh, we'll send a request for check verification and verify if it's clear or not. If not, then we can void and reissue.
[AGENT][NEUTRAL] Uh, is there anything
[CUSTOMER][NEUTRAL] OK. Could you please send the request?
[AGENT][NEUTRAL] As I said that, I will send a request for the check verification. If the check shows it has not cleared, then we will have a, have a check for and reissued. Is that the correct mailing address?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, that's the direct mailing address.
[AGENT][NEUTRAL] OK, and [PII], is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] That's it for today. May I know the claim number?
[AGENT][NEUTRAL] 354-1184.
[CUSTOMER][NEUTRAL] May I know the color reference number for the Diego?
[AGENT][NEUTRAL] Uh, we don't give call reference numbers. So if you like, you may use my name in today's date.
[CUSTOMER][POSITIVE] OK. Thank you for your service. Have a wonderful day. Take care. Bye-bye.
[AGENT][POSITIVE] You too, [PII]. Thanks for calling APL. Bye.