AccountId: 011433970860
ContactId: c2498ceb-ba5a-4ff2-92e7-27fedbce3203
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 537919 ms
Total Talk Time (AGENT): 117684 ms
Total Talk Time (CUSTOMER): 83547 ms
Interruptions: 1
Overall Sentiment: AGENT=-0.2, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/26/c2498ceb-ba5a-4ff2-92e7-27fedbce3203_20250626T12:22_UTC.wav
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[AGENT][NEUTRAL] APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm [PII] calling from the provider's office to check on a claim status.
[AGENT][NEUTRAL] OK, [PII]. Happy to check on a claim. Do you have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, ma'am. It is 024.
[CUSTOMER][NEUTRAL] 650
[CUSTOMER][NEUTRAL] 58.
[AGENT][NEUTRAL] Thank you. Let me pull that up here, one moment. And for documentation, do you have a good callback number?
[CUSTOMER][NEUTRAL] It is 844.
[CUSTOMER][NEUTRAL] 608
[CUSTOMER][NEUTRAL] 2407.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you and then data service.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Date of service is [PII].
[AGENT][NEUTRAL] OK. And then do we have a bill amount?
[CUSTOMER][NEUTRAL] Uh, it's 407-310.01.
[AGENT][NEUTRAL] OK. One moment.
[AGENT][NEUTRAL] Do we by chance have a different amount after primary paid?
[CUSTOMER][NEUTRAL] Mm, uh, one moment, ma'am.
[CUSTOMER][NEUTRAL] Um, you're asking for the primary paid amount?
[AGENT][NEUTRAL] I'm asking, yeah, if there's a remaining amount once the primary paid that was different than the 407,000.
[CUSTOMER][NEUTRAL] Uh sorry, ma'am. I don't, I don't have that information.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Do you have a claim number?
[CUSTOMER][NEUTRAL] Um, yes, it is 359.
[CUSTOMER][NEUTRAL] 5920.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So that claim is reading as um
[AGENT][NEUTRAL] A duplicate. It was previously submitted to the insurance by the insured and so the insured filed their own claim, and then the benefit was sent to the insured.
[CUSTOMER][NEUTRAL] Um, OK.
[AGENT][NEUTRAL] So the claim number ending in 5.
[CUSTOMER][NEUTRAL] Uh, could you please provide me the
[CUSTOMER][NEUTRAL] Yes, ma'am. Could you please provide me the original claim status which was submitted by the insured?
[AGENT][NEUTRAL] Uh, that claim was received on [PII] and it was processed and paid to the insured.
[CUSTOMER][NEUTRAL] OK. May I know the reason why it was paid to the insured?
[AGENT][NEUTRAL] The insured filed the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know the allowed amount and the paid amount?
[AGENT][NEGATIVE] I'm not able to give you the paid amount.
[AGENT][NEUTRAL] The inpatient benefit max for this patient's plan is $6000.
[AGENT][NEUTRAL] And their outpatient benefit max on this plan is per calendar day, which is $500.
[CUSTOMER][NEUTRAL] Uh, this claim needs to be paid by the patient.
[AGENT][NEUTRAL] It was paid to the patient, yes. Is that, was that your question?
[CUSTOMER][NEUTRAL] OK. May I know the patient responsibility, please?
[AGENT][NEUTRAL] We're not able to advise on patient responsibility, that's up to the facility or the provider.
[CUSTOMER][NEUTRAL] So the bill was submitted to the insured, then how much, how, uh, which amount the insured need to be paying? That is the patient responsibility, right?
[AGENT][NEUTRAL] We can, we can advise on patient responsibility.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] What other information did you need?
[CUSTOMER][NEUTRAL] I need to know whether it was paid if the claim was completed.
[AGENT][NEUTRAL] Yes, the claim was paid to the insured.
[CUSTOMER][NEUTRAL] You know that how, how much amount the patient is paid.
[AGENT][NEGATIVE] I can't give that information.
[CUSTOMER][NEUTRAL] Sorry, how much I want to pay for the patient?
[AGENT][NEUTRAL] Yeah, I can't give that information to you. I'm sorry.
[AGENT][NEUTRAL] Is there anything else?