AccountId: 011433970860
ContactId: ce0af649-a918-424d-a29e-8a279afa763e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 631890 ms
Total Talk Time (AGENT): 162597 ms
Total Talk Time (CUSTOMER): 145019 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/31/ce0af649-a918-424d-a29e-8a279afa763e_20241231T20:19_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the provider's office to check on a claim status.
[AGENT][POSITIVE] OK, I'll be more than happy to assist you with the claim status. And [PII], um, how many claims do you have today in total?
[CUSTOMER][NEUTRAL] Uh, I do have um just 2 games.
[AGENT][NEUTRAL] I'm sorry, it's really hard to hear you. You sound muffled.
[CUSTOMER][NEUTRAL] 22 games.
[AGENT][NEUTRAL] OK, and [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] [PII] direct line and the policy number is 01677458 M as in Mike.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Patient's first name and last name are [PII] and the date of birth is on.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. May I have the date of service for the claim you'd like me to check on?
[CUSTOMER][POSITIVE] I do have a clear number if you want me to do that, I can give you directly.
[AGENT][NEUTRAL] OK, did you have questions in reference to the claims?
[CUSTOMER][NEUTRAL] Yes, uh, I want to know that the reason of this claim.
[AGENT][NEUTRAL] OK, and what claim numbers do you have?
[CUSTOMER][NEUTRAL] 352-016-2
[AGENT][NEUTRAL] OK, was there more than one?
[CUSTOMER][NEUTRAL] Uh, I just want this same number.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] I'm sorry I couldn't get you.
[AGENT][NEUTRAL] Do you have any other claim numbers that you would like me to look the denial reason up for?
[CUSTOMER][NEUTRAL] No, no, no, this is the only one.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] This claim was not denied. This claim was paid out on, um, a total of $41.
[CUSTOMER][NEUTRAL] Sorry, could you please, uh, the claim was paid for $41.
[AGENT][POSITIVE] Yes, that's correct. The claim was not denied. Um, it was paid out on a total of $41 to the provider.
[CUSTOMER][NEUTRAL] OK, just a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, may I know your name?
[AGENT][NEUTRAL] Yes, my name is [PII]
[CUSTOMER][NEUTRAL] Uh, [PII], could you please tell me when this claim was on?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] When this claim was received on.
[AGENT][NEUTRAL] The claim was received on [PII].
[CUSTOMER][NEUTRAL] [PII], and when was this process on?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, uh, so you said that the claim was paid and what is the amount?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Uh, just a moment, [PII]. One moment, I'll be back.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What time.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And uh, hello?
[AGENT][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] Yeah, [PII], could you please tell me what is the amount?
[AGENT][NEUTRAL] Yes, I'm searching on the fax back. Hold on one moment, I'm looking for the code.
[AGENT][NEUTRAL] Because this is on a fee schedule, so each code has a dollar amount. Hold on one moment.
[CUSTOMER][NEUTRAL] Just a moment, [PII].
[AGENT][NEUTRAL] And actually, OK.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][POSITIVE] I extremely sorry for the delay. Uh, could you please stay online?
[AGENT][NEUTRAL] So the allowed amount for extractions for a single tooth on this policy is $41.
[AGENT][NEUTRAL] And that's the amount that was applied?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, and what is the pay amount?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Paid amount, paid amount.
[AGENT][NEUTRAL] The paid amount again is $41.
[CUSTOMER][NEUTRAL] OK, a lot amount and paid amount the same. Is there any additional responsibility?
[AGENT][NEUTRAL] Yes, $48.
[CUSTOMER][NEUTRAL] OK, could you please tell me, uh, what happened to the remaining account balance?
[AGENT][NEUTRAL] Sorry?
[CUSTOMER][NEUTRAL] Actually the claim was for 10 1500 $1500 right.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] This, the total of this claim was $89.
[CUSTOMER][NEUTRAL] Uh, the total of this claim for $89. Just a moment, let me check that.
[CUSTOMER][NEUTRAL] Just a moment, [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you, thank you for your patience.
[CUSTOMER][NEUTRAL] OK, could you please tell me what is the mode of payment?
[AGENT][NEUTRAL] Uh, for the claim, like how was the claims payment sent to you?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It was a single check?
[CUSTOMER][NEUTRAL] And uh could you please
[AGENT][NEUTRAL] The check
[CUSTOMER][NEUTRAL] Yeah, yeah, go on.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Yeah, I'm about to site number.
[AGENT][NEUTRAL] The check number is 2013698.
[AGENT][NEUTRAL] It was sent, um,
[AGENT][NEUTRAL] As a single check on [PII], and it cleared on [PII].
[AGENT][NEUTRAL] It was mailed to [PII].
[CUSTOMER][NEUTRAL] Uh, cleared on [PII], right?
[AGENT][NEUTRAL] [PII], yes.
[CUSTOMER][POSITIVE] Oh thank you, thank you for this information and uh.
[CUSTOMER][NEUTRAL] Uh, that's all I have got everything what I needed, and, uh, could you please send us a copy of an email will be through fax.
[AGENT][NEUTRAL] Yes, what's a good fax number for you?
[CUSTOMER][NEUTRAL] Sure, our fax number is [PII].
[CUSTOMER][NEUTRAL] [PII] with the attention of [PII].
[AGENT][NEUTRAL] [PII] is the attention.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And that's the fax number [PII]?
[CUSTOMER][NEUTRAL] That's it.
[AGENT][NEUTRAL] All right. So I'll go ahead and fax this over to you now, [PII]. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, I have got everything what I needed, and uh thank you for your time and assistance, [PII].
[AGENT][POSITIVE] You're welcome and thanks for calling APL. I hope you have a happy New Year.
[CUSTOMER][POSITIVE] Happy New Year. Thank you.
[AGENT][POSITIVE] Thank you. Bye-bye.