AccountId: 011433970860
ContactId: b53ad88c-8df3-4f74-ba1b-875bf9b2353f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 454559 ms
Total Talk Time (AGENT): 195429 ms
Total Talk Time (CUSTOMER): 99521 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/b53ad88c-8df3-4f74-ba1b-875bf9b2353f_20250114T22:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, I'm checking on a claim for a patient please.
[AGENT][POSITIVE] OK, I'm happy to check on a claim today. Do you have their policy number?
[CUSTOMER][NEUTRAL] I do.
[CUSTOMER][NEUTRAL] That is 002497261.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me pull this up here.
[AGENT][NEUTRAL] And if you don't mind, can I get your first name please and a callback number?
[CUSTOMER][NEUTRAL] Yes, it is [PII] and the phone number is [PII].
[AGENT][NEUTRAL] All right. Thanks, [PII]. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And then what is the date of service?
[CUSTOMER][NEUTRAL] Um, there's [PII] is [PII], and then [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And for data service [PII], do we have a billed amount?
[CUSTOMER][NEUTRAL] Um, I show 211 on my side.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it looks like this claim was received for 122. Looks like it was denied the calendar year policy maximum, um, had already been exhausted.
[CUSTOMER][NEUTRAL] OK, um, it was new insurance, so that's why the patient's just kind of confused by that. She hadn't used it at all.
[AGENT][NEUTRAL] Uh let's see.
[CUSTOMER][NEUTRAL] So, I don't know how to tell.
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] Um, and then what did you have for this 123 also you had?
[CUSTOMER][NEUTRAL] Correct, yeah, that one was 3 fillings billed them out is 566.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me pull this plan and see.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] It looks like the calendar year maximum on her plan is $500. So let me go let me go back to.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I was trying to find that first so we could.
[AGENT][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Yeah, no, for sure, I get that.
[AGENT][NEUTRAL] See, and then 123 24, you said the bill amount was 566.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The red shirt
[AGENT][NEUTRAL] OK, so it looks like the other insured, so [PII] is the other person I believe on this plan. Let me see. Yes, or [PII].
[CUSTOMER][NEUTRAL] It's [PII], but yeah, I think it's misspelled on your side.
[AGENT][NEUTRAL] Oh, it's supposed to be [PII], isn't it? It is misspelled.
[CUSTOMER][NEUTRAL] Oh, it is [PII], yes.
[AGENT][NEUTRAL] Sorry, OK.
[CUSTOMER][NEUTRAL] I know when it came back I couldn't remember if I was like, did they do [PII] wrong or [PII] wrong yeah.
[AGENT][NEUTRAL] It's [PII] sorry, OK, alright, so on on [PII] there was a claim that came in for that. Let me see what the total gonna add these up really quick.
[CUSTOMER][POSITIVE] OK, no, no worries.
[AGENT][NEUTRAL] Um, OK, so the billed amount for that looks like was 566. So for that claim on [PII], we sent a benefit payment for 23,360.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and so,
[CUSTOMER][NEUTRAL] And that probably maxes her out for the year because it does look like there was 266 earlier in the year.
[AGENT][NEUTRAL] Right, so that's what I was gonna say she had another claim like later in October that paid 26,640, so that was the whole 500, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, yeah, I see that one. OK, so we never received that claim for the date of or the payment for date of service [PII]. I don't know if there's a way to track that, um, but we haven't received that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let's go back and check that. Let's see, 3, OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, so that was sent to [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, what is today's date or the [PII]? OK, so I showed the issue date on this payment was [PII]. So we do have to wait 30 days, [PII]. It does show still outstanding. Um, if you guys don't have it by the [PII], definitely call us and we'll void it and then reissue a new check.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect and can you tell me that amount once more just for my notes?
[AGENT][NEUTRAL] Yeah, absolutely. So that check amount was for $233.60.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] I can give you the check number too if you need it.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Uh, the check number is 2019835.
[CUSTOMER][POSITIVE] OK perfect I will give you a call if we haven't seen it by the end of the month then.
[AGENT][POSITIVE] Sounds good. Anything else I can check for you?
[CUSTOMER][POSITIVE] That's it thank you so much.
[AGENT][POSITIVE] You're welcome. Have a good one, [PII].
[CUSTOMER][POSITIVE] OK you too bye bye.
[AGENT][NEUTRAL] Bye.