AccountId: 011433970860
ContactId: c222dec0-2cfd-49d9-8b0c-e9189fe8fef2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 579359 ms
Total Talk Time (AGENT): 156254 ms
Total Talk Time (CUSTOMER): 347119 ms
Interruptions: 6
Overall Sentiment: AGENT=1.2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/c222dec0-2cfd-49d9-8b0c-e9189fe8fef2_20250212T21:54_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, hey, good afternoon. This is [PII] calling you from the provider office. How are you doing today?
[AGENT][POSITIVE] I'm good, thank you. How about you, Mr. [PII]?
[CUSTOMER][NEUTRAL] Yes, I'm very good. OK, so I'm just calling you regarding, I just wanna know, yeah, I'm just, I just wanna know the general claim status, so could you please help me with that?
[AGENT][NEUTRAL] How may I help you?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure, I can assist you with claims.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, the callback number is going to be [PII].
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] the hotel.
[AGENT][NEUTRAL] OK, and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Mhm mhm.
[CUSTOMER][NEUTRAL] Uh, the patient, sorry?
[CUSTOMER][NEUTRAL] Which number?
[AGENT][NEUTRAL] Patient's policy number?
[CUSTOMER][NEUTRAL] Sure. The policy number is going to be, let me check that. It's 2274045.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Sure. The name is [PII]. And let me tell you the date of birth. Just bear with me. OK. The date of birth is going to be [PII].
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And this is for dental Mr. [PII]?
[CUSTOMER][NEGATIVE] Sorry, come again.
[AGENT][NEUTRAL] Is this for dental? The claim is it for dental?
[CUSTOMER][NEUTRAL] Not for the
[CUSTOMER][NEUTRAL] For the medical.
[AGENT][NEUTRAL] Medical?
[AGENT][NEUTRAL] OK, let me see if I can find the medical policy, the one you gave me, so dental, one moment.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, it might be the, uh, like the mistake with the policy number because I can see here, uh, in the system, the policy number in the, in the starting 02274045.
[CUSTOMER][NEUTRAL] The complete policy number.
[AGENT][NEUTRAL] Yeah, that's, yeah, that's not the medical, that's the dental. One moment.
[CUSTOMER][NEUTRAL] OK, just a minute.
[AGENT][NEUTRAL] OK, I found a medical one, and what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yes, I'm here. Uh, what was you saying?
[AGENT][NEUTRAL] Date of service and amount of the claim.
[CUSTOMER][NEUTRAL] OK. The date of service is going to be [PII]. And let me tell you the charge amount, just a moment, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, here, here we go. OK.
[CUSTOMER][NEUTRAL] OK, so the charge amount is going to be $800.95 $95.06. Mhm.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] My pleasure.
[CUSTOMER][POSITIVE] Mm, soon I get gray for you, gray for you, let me show you how row and to be it is as soon as not.
[CUSTOMER][POSITIVE] Mhm. Sure, take your time.
[AGENT][NEUTRAL] OK, bear with me just a second.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, so how's your day going so far?
[AGENT][POSITIVE] It's all right. There's a storm out there, but yeah, it's OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And you're working from home or from the like the office? OK, that's good.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm waiting on the ALB. It's going up.
[CUSTOMER][NEUTRAL] OK, that's fine.
[CUSTOMER][NEUTRAL] Mhm mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I just need it so good and it it be someone.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The main uh medication for learning skill that she and other.
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][POSITIVE] Let me show you how proud I am to be, yeah, sorry.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it looks like we processed the claim on [PII].
[CUSTOMER][NEUTRAL] plastic out.
[AGENT][NEUTRAL] And we send a benefit amount of $75 to the provider.
[CUSTOMER][NEUTRAL] OK, and when it was processed?
[AGENT][NEUTRAL] [PII] is the process date.
[CUSTOMER][NEUTRAL] With
[CUSTOMER][NEUTRAL] And when did you receive this claim?
[AGENT][NEUTRAL] It was received on [PII].
[CUSTOMER][NEUTRAL] OK, [PII], OK, and it was paid or denied?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We pay $75 which is the maximum for that date of service.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. So, and is there any kind of allowed amount or the co-pay or the co-insurance or deductibles?
[AGENT][NEUTRAL] Mm. No, this, this is not a major medical. So, uh, this is a hospital indemnity plan, so we pay flat amounts. Anything over it's gonna be the, um, well, it could be patient's responsibility of or it's up to the provider's discretion because we don't have any contractual involvement. We're not a major medical. So it looks like the $75 was the maximum benefit and that's what we covered, $75.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. So the thing is, the insurance pays $75 and the rest of the amount is the patient responsibility, right?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] It's up to the provider's discretion. We cannot really tell you what to do with the remaining, mhm, yeah.
[CUSTOMER][NEUTRAL] Except for one.
[CUSTOMER][NEUTRAL] OK, OK, just a moment. I got it. OK. uh, uh.
[AGENT][NEUTRAL] Yeah. Yeah right.
[CUSTOMER][NEUTRAL] OK, the claim paid amount. Just a moment, I'm just writing the things, OK.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh, it's $75 right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, responsibility.
[CUSTOMER][NEUTRAL] Responsibility.
[CUSTOMER][NEUTRAL] Provider, OK.
[CUSTOMER][POSITIVE] OK, thank you so much for helping with helping with that. OK, just a moment.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And so may I have the reference number and your gorge's name?
[AGENT][NEUTRAL] My name is [PII]. That's [PII].
[AGENT][NEUTRAL] Last initial is [PII], and we don't have reference numbers. You can use my name and today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So, OK, so, OK. What is, uh, what is the meaning of your name, do you know?
[AGENT][NEUTRAL] So.
[CUSTOMER][NEUTRAL] OK, OK. [PII].
[AGENT][NEUTRAL] Then yeah, the sun, yeah, the sun in the sky.
[CUSTOMER][POSITIVE] OK. OK, OK. That's good to hear. OK. So thank you so much, sir. It was very helpful for me and it was lovely to talking with you. And so, OK, that's it. So, and if I need any kind of assistance, I will uh give you a call and we will do that. OK? Thank you so much for your patience and time.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I see.
[AGENT][POSITIVE] Yeah, good day. All right.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] No problem.
[AGENT][POSITIVE] You're welcome, Mr. [PII], and thank you for calling APO. Have a good day. Good afternoon.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah.