AccountId: 011433970860
ContactId: d50324bc-f77c-4458-aad0-c266baa82728
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 316250 ms
Total Talk Time (AGENT): 87791 ms
Total Talk Time (CUSTOMER): 155885 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/d50324bc-f77c-4458-aad0-c266baa82728_20250213T15:33_UTC.wav
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[AGENT][NEUTRAL] APL, my name is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Hi [PII], how are you? Good, my name is [PII] and I'm calling from Bay with healthcare Vital the group holding for patients claim status, please.
[AGENT][POSITIVE] I'm good how are you?
[AGENT][POSITIVE] I'd be happy to assist with claim status today buddy, if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Policy number is 023126664.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] Her name is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] And the date of service for the claim.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what's your tax ID?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that information. So I'm showing that a payment was made in the amount of $1,068.68.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that was made on.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] For date of service uh [PII], right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, um, so the charge amount that we billed to you guys was 1,851, correct?
[AGENT][NEUTRAL] I'm showing the patient responsibility was $1,139.63 but the amount that we paid was the all that she had left for her outpatient benefits for the year, so that payment maxed her out.
[CUSTOMER][NEUTRAL] Mm, so you guys weren't able to cover that.
[AGENT][NEUTRAL] Not the entire thing, no, so whatever we didn't pay is a patient. I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] How much did you
[CUSTOMER][NEUTRAL] No, no, sorry, how much were you guys able to pay?
[AGENT][NEUTRAL] I said the $1,068.68.
[CUSTOMER][NEUTRAL] Uh, 1000.
[CUSTOMER][NEUTRAL] OK, can you repeat that? I, I think it's my phone. Hold on, give me one second, let me.
[CUSTOMER][NEUTRAL] OK. Hello?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] You said 1000? I'm sorry.
[AGENT][NEUTRAL] $1,068.68. That's what we pay. Anything other than that is gonna be patient responsibility because that was the last of her outpatient benefits for the year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it. uh, let me see. OK, do you have a claim number for this one?
[AGENT][NEUTRAL] Claim number is 356-0914.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 356-091-4. OK.
[CUSTOMER][NEUTRAL] Does it show on your end by any chance how much is she gonna be responsible?
[AGENT][NEUTRAL] We don't determine patient responsibility.
[CUSTOMER][NEUTRAL] OK, OK, alright, and do you mind helping me with another patient, please?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] Mhm thank you.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] It is 02496828.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, her date of birth is [PII].
[CUSTOMER][NEUTRAL] Her name is [PII].
[AGENT][NEUTRAL] Data service for the claim?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The date of service for the claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'm not sure we have that on file.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] That's weird. It says here well we faxed it to you guys.
[CUSTOMER][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] Last time with you'll be attached.
[AGENT][NEUTRAL] I'm not sure we have it.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mm, OK, let me just confirm the fax number.
[CUSTOMER][NEUTRAL] Let's see, fax number was 877.
[CUSTOMER][NEUTRAL] 3659423
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well that's weird. OK, so we should just resend it right?
[AGENT][POSITIVE] That's correct. Mhm.
[CUSTOMER][POSITIVE] OK, thank you so much for your help, OK?
[AGENT][NEUTRAL] Was there anything else I can assist with today?
[CUSTOMER][POSITIVE] No, that'll be all. Thank you.
[AGENT][POSITIVE] Thank you for calling APL you have a good day.
[CUSTOMER][NEUTRAL] OK