AccountId: 011433970860
ContactId: d436102e-e139-4b83-a390-c59af51e4b35
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 174970 ms
Total Talk Time (AGENT): 67404 ms
Total Talk Time (CUSTOMER): 56747 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/d436102e-e139-4b83-a390-c59af51e4b35_20250225T16:43_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, my name is [PII]. I'm calling from Gastro Med regarding a claim.
[AGENT][NEUTRAL] OK, I can verify claim status for you. And what is that policy number, Ms. [PII]?
[CUSTOMER][NEUTRAL] 01749816 M as in Mary, L as in Larry, 8.
[AGENT][POSITIVE] OK, thank you so much. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK. Thank you so much. And verify that patient's name, date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII] [PII].
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] You say you're calling for claim status, correct?
[CUSTOMER][NEUTRAL] Well, I'm calling. We received the payment but it doesn't like show it and the portion is member responsibility so I just need to confirm all that.
[AGENT][NEUTRAL] OK, um, well, what was the claim number, the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] It is November 26, 2024 with a billed amount of $459.
[AGENT][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] And the balance after primary?
[CUSTOMER][NEUTRAL] Is 25219.
[AGENT][NEUTRAL] OK, it looks like we paid 3330, and it looks like with the payment of that claim it maxed their benefit. Our EOBs wouldn't have patient responsibility. It would just say like with the payment of this claim, it matched the benefit for the year, but we wouldn't give patient responsibility. We can only verify how it processed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] So would that mean that though the balance is the patients?
[AGENT][NEUTRAL] Well, we don't know if they have any other insurance, uh, so you just have to contact the patient, but it could be.
[CUSTOMER][NEUTRAL] OK perfect and is there a call reference number?
[AGENT][NEUTRAL] Uh, no, ma'am. If you like, you may use my name in today's date.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Alright, you're welcome, Ms. [PII], and thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You