AccountId: 011433970860
ContactId: c847039e-86b1-47c9-9e7b-28d17cc9bd88
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 453209 ms
Total Talk Time (AGENT): 159860 ms
Total Talk Time (CUSTOMER): 138135 ms
Interruptions: 3
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/c847039e-86b1-47c9-9e7b-28d17cc9bd88_20250218T19:42_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office to claim status. Could you spell your name, please?
[AGENT][NEUTRAL] [PII] and [PII], your callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. And you said that you have one claim to check status on [PII], is that correct?
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] Yes, I can help you. And what is your, uh, excuse me, the patient's policy number?
[CUSTOMER][NEUTRAL] It's 02521741.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm sorry for the interruption. Before that, could you reconfirm your name, please? It's [PII], is that right?
[AGENT][NEUTRAL] No, sir. My name is [PII]
[CUSTOMER][NEUTRAL] Yeah, [PII], my mistake.
[AGENT][NEUTRAL] And my name in today's date will also be your call reference number, [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And enjoy giving the information that I do want for you will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] right.
[CUSTOMER][NEUTRAL] Yeah it's uh.
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] It's uh [PII] and the total bill amount is $8,674 even.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][POSITIVE] OK, thank you for that. OK, thank you for assisting me.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, this was received on [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Pardon, could you repeat that again?
[AGENT][NEUTRAL] The claim was received on [PII] and it was processed on [PII].
[CUSTOMER][NEUTRAL] Just a moment. [PII] and the process on [PII], right?
[AGENT][NEUTRAL] The claim number is 3.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Claim number
[AGENT][NEUTRAL] The claim number is 35618887.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] There was a benefit paid in the amount of $179 excuse me, the benefit paid was $174.49.
[CUSTOMER][NEUTRAL] OK, may I know the pay amount?
[AGENT][NEUTRAL] That was
[AGENT][NEUTRAL] That was the paid amount, 174.49.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. So may I know what is the amount?
[AGENT][NEUTRAL] The check number. The check number is 202-7250.
[AGENT][NEUTRAL] And the remark on this claim states with this check, the maximum benefit payable for this state of service has been met.
[CUSTOMER][NEUTRAL] OK, [PII], could you tell me the allowed amount for this claim?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] The outpatient benefit maximum per calendar day is $200 for covered services.
[AGENT][NEUTRAL] With no deductible?
[CUSTOMER][NEUTRAL] So the other amount is $200 and the paid amount is $174.49. Is that right?
[AGENT][NEUTRAL] That is correct because there was about the remainder of that was paid on another claim.
[AGENT][NEGATIVE] For a different provider that I cannot provide you.
[CUSTOMER][NEUTRAL] OK. Is there any patient responsibility?
[AGENT][NEUTRAL] We do not determine patient responsibility, that would be up to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is it a single payment or bulk payment?
[AGENT][NEUTRAL] Single amount on the check number that I provided for you?
[CUSTOMER][NEUTRAL] OK. May I know the check issue date?
[AGENT][NEUTRAL] The same date as the process date.
[CUSTOMER][NEUTRAL] On the process date, the check was issued.
[CUSTOMER][NEUTRAL] Just a moment, [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, thank you for being on hold, [PII]. Uh, could you tell me that is the check has been cashed or, uh, is it in the process?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] The check is still open at this, at this time?
[CUSTOMER][NEUTRAL] OK. Could you tell me the page address of the check?
[AGENT][NEUTRAL] You can verify the address that was on the claim form.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. It's uh [PII]. And the ZIP code is [PII]. Is that right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. Just a moment, sir.
[CUSTOMER][NEUTRAL] Thank you for being on hold, uh, [PII]. Could you tell me the call reference number for this claim, please?
[AGENT][NEUTRAL] Yes, sir, you're gonna use my name along with today's date and if you need a copy of this explanation of benefits, [PII], you may print that by going to our.
[CUSTOMER][NEUTRAL] yeah.
[AGENT][NEUTRAL] By going to our portal at [PII].
[CUSTOMER][POSITIVE] OK. Thank you, [PII].
[CUSTOMER][POSITIVE] OK. Thank you, [PII]. Thank you for your assistance. Have a, have a nice day. Bye.
[AGENT][POSITIVE] You're welcome. Yes, you're welcome.
[AGENT][POSITIVE] Yes, sir, if that's all I can help you with. Thank you again for calling APL [PII], and I hope you have a nice evening also.
[CUSTOMER][NEUTRAL] Yeah, you just.
[AGENT][NEUTRAL] Mhm.