AccountId: 011433970860
ContactId: b45371da-ca23-4a9a-9dc0-3fa4113c76d7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 419500 ms
Total Talk Time (AGENT): 102637 ms
Total Talk Time (CUSTOMER): 157345 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/b45371da-ca23-4a9a-9dc0-3fa4113c76d7_20250620T15:20_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling you from provider office looking for claim status.
[AGENT][NEUTRAL] Sure, [PII], I can assist you with claim status. And first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Direct line?
[AGENT][NEUTRAL] Thank you. OK, thank you. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] 02538256
[AGENT][NEUTRAL] Please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] Sorry. It is [PII] and the birth date, [PII].
[AGENT][NEUTRAL] OK. Thank you. Now I need the date of service and bill charges on the claim.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the bill amount is $6,306 even.
[AGENT][NEUTRAL] OK, one moment, please.
[AGENT][NEUTRAL] OK, and I'm still waiting on my system. One moment.
[CUSTOMER][POSITIVE] Take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK. Yes, sir. Thanks for your patience. Um, I'm showing that we received this claim on [PII].
[AGENT][NEUTRAL] The claim processed on [PII].
[AGENT][NEUTRAL] The claim number is 358-8992.
[AGENT][NEUTRAL] And I'm showing that the claim paid out for $1,955 even. It was a single check.
[AGENT][NEUTRAL] And the check number is 203-9171.
[AGENT][NEUTRAL] I'm showing that it was.
[CUSTOMER][NEUTRAL] Uh, actually,
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh, sorry to cut you out. Actually, for this one, we received payment of $1,955 even. But uh it was paid as secondary, right?
[AGENT][NEUTRAL] Yes, it was paid.
[CUSTOMER][NEUTRAL] And primary left more than this. Uh, actually, primary left more than this, uh, primary process claim, and he left the deductible amount of $3,249.59. 3249.59 cents. And whereas we receive payment only one.
[CUSTOMER][NEUTRAL] 955 from secondary only.
[AGENT][NEUTRAL] OK. You receive that amount because under this policy, we only cover up to
[AGENT][NEUTRAL] $2,025 per calendar year and the uh benefit maxed out for the calendar year.
[CUSTOMER][NEUTRAL] OK. So for the calendar year 2025, the maximum payment can be made $1,955 right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh, is it for the single claim or for annual year?
[AGENT][NEUTRAL] Per annual year.
[CUSTOMER][NEUTRAL] Because, uh, apart from this, I'm seeing other payments also where we receive $70 like other date of service which belongs to February month where we received $70 and uh give me a moment. Let me check one more thing here.
[CUSTOMER][NEUTRAL] OK. So, the payment amount which is made $1,955 this payment, uh, with this payment, the benefit has been exhausted for this covered person, right? For this year.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] And no payment can be made for this year, and another claim also, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] All right. And for the leftover balance which we have, uh, so was it uh for patient responsibility because uh we, there are some balance.
[CUSTOMER][NEUTRAL] From the patient side because primary life deductible and secondary only paid 1955 only.
[CUSTOMER][NEUTRAL] So the leftover balance is 1002. Mhm. Go ahead.
[AGENT][NEUTRAL] Yes, the remaining
[AGENT][POSITIVE] Yes, yes, the remaining is patient responsibility.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK, no issue. And uh can I get the call reference number for this entire call?
[AGENT][NEUTRAL] Yes, sir. For the reference number, you can use my name and today's date. My name is [PII]. Um it's spelled [PII] Last initial is [PII] and today's date. Um, is there anything else I can assist you with?
[CUSTOMER][POSITIVE] Uh, nope, I think that's all for today. Thank you so much for your help.
[AGENT][POSITIVE] OK. I thank you for calling APL, Ben. You have a great rest of your day. Mm bye.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.