AccountId: 011433970860
ContactId: c8e45e36-b6d9-4d0b-ba07-75ef450a0c1c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 353899 ms
Total Talk Time (AGENT): 135041 ms
Total Talk Time (CUSTOMER): 163841 ms
Interruptions: 7
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/c8e45e36-b6d9-4d0b-ba07-75ef450a0c1c_20250211T17:11_UTC.wav
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[CUSTOMER][NEUTRAL] So.
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from provider's office.
[AGENT][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] Yeah, P as in Papa. G as in Golf.
[AGENT][NEUTRAL] You said your name is [PII]?
[AGENT][NEUTRAL] Oh, PG, OK, and PG, how may I assist you today?
[CUSTOMER][NEUTRAL] I'm calling for a claim information.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the claims and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Just one.
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah. The contact number is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have um the member's policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Member's policy number.
[CUSTOMER][NEUTRAL] That is 018960.
[CUSTOMER][NEUTRAL] 58 the letter M as in Mike and L as in Lima and the number 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] one.
[CUSTOMER][NEUTRAL] Yeah, the number's first name is [PII].
[CUSTOMER][NEUTRAL] Number's last name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Yeah. The date of service is [PII].
[CUSTOMER][NEUTRAL] Total bill amount is $993.87.
[AGENT][NEUTRAL] Thank you for that. And may I have um the total bills?
[AGENT][NEUTRAL] And again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's AdventHealth News Marina Beach.
[CUSTOMER][NEUTRAL] You know that's it.
[AGENT][NEUTRAL] Alright, so I'm sure we received the claim on [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 343.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] 1124.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was paid out to the provider.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] A total of $500.
[CUSTOMER][NEUTRAL] Hello
[AGENT][NEUTRAL] Did you need the check information?
[CUSTOMER][NEUTRAL] Yeah, no, but regarding this, I can see the claim has been processed as primary.
[AGENT][NEUTRAL] Um, no, APL is not primary. We are the secondary insurance.
[CUSTOMER][NEUTRAL] OK, you guys have processed the claim as secondly.
[AGENT][NEUTRAL] Yes, we're 2nd to United Healthcare.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Uh,
[CUSTOMER][NEUTRAL] Yeah, you can go ahead with the check details as well.
[AGENT][NEUTRAL] OK, so it's a single check in the amount of $500?
[AGENT][NEUTRAL] The check number is 1841176.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was issued on [PII].
[AGENT][NEUTRAL] And it cleared on [PII].
[CUSTOMER][NEUTRAL] OK. Uh, it, uh, there's no denial on the claim, correct?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] It was paid.
[CUSTOMER][NEUTRAL] OK, uh, but as per our record, yeah, uh, expected amount that has been transferred out from the primary is $799.06.
[AGENT][NEUTRAL] Correct, and of that 5.
[CUSTOMER][NEUTRAL] And the claim got paid only for 4.
[AGENT][NEUTRAL] So you're wanting to know why only 500 was applied to the claim?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So the benefit, hold on one moment, let me go to what was used. So the outpatient benefit is up to $500 per calendar day. So no matter what the claim amount was, the max is $500 so that max was applied to your claim.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And the member is also not responsible for the uh balance amount, correct?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, and the member is also not responsible for the balance amount.
[AGENT][NEUTRAL] Um, we don't
[AGENT][NEUTRAL] We don't provide patient responsibility. We don't determine that because we're not the major insurance company. If there's an outstanding balance, um, that would just be whatever your protocols are for outstanding or remaining balances.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for the information, [PII]. I just need the call reference number now.
[AGENT][NEUTRAL] Oh, you're very welcome. There is no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK, uh, just for the, it's [PII]. Am I correct?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] All right, and PG, was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, that's it, [PII]. Thank you so much for the information. Have a great day.
[AGENT][POSITIVE] You're very welcome. You also, and thanks for calling APL.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Yeah, you too. Bye-bye.