AccountId: 011433970860
ContactId: db8b43d8-be5d-40cd-8a61-e81876dab494
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 727010 ms
Total Talk Time (AGENT): 186026 ms
Total Talk Time (CUSTOMER): 138025 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=-1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/db8b43d8-be5d-40cd-8a61-e81876dab494_20250610T20:12_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh yes, I just wanted to check on a claim.
[AGENT][NEUTRAL] Sure, I can assist you with claim status. And may I have your name?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] Mm. Yeah, and Ms. [PII], you're calling from a provider's office or this is your personal policy?
[CUSTOMER][NEUTRAL] A provider's office.
[AGENT][NEUTRAL] OK, and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] Thank you. And what's the name of the facility you're calling from for my notes?
[CUSTOMER][NEUTRAL] Sure. South Carolina Endoscopy Center.
[AGENT][NEUTRAL] OK, thank you. And Miss [PII], may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Sure. It's 01991588.
[AGENT][NEUTRAL] All right, thank you. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Sure, [PII], date of birth [PII].
[AGENT][NEUTRAL] Thank you. And may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Sure, it's [PII] for 975.
[AGENT][NEUTRAL] OK, thank you. Alright, let me see if I can find this claim, and that was [PII] for 975.
[AGENT][NEUTRAL] And for future you can check claim status online through our website at [PII] and that's just optional and let me see, let me see if I got it.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] What is the procedure code?
[CUSTOMER][NEUTRAL] Uh, let me see real quick. It is uh 453-85. It's like a colonoscopy.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] 35, OK. I think it's gonna be, let me pull this ELB.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it looks like we processed this claim. Um, well, this one is a little bit more than that. Um, bear with me, is it just 975 or is it a little bit more than that?
[CUSTOMER][NEUTRAL] Yeah. Yeah, you probably got the other bill from our physician and his would be a little bit more, uh, but this is the facility side, so it's only South Carolina endoscopy. And uh I did mail everything in the [PII].
[AGENT][NEUTRAL] Mm OK.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, um, let me try this other claim, let's see.
[AGENT][NEUTRAL] Let me look at these details.
[AGENT][NEUTRAL] What's the remaining balance?
[CUSTOMER][NEUTRAL] Uh, let's see, right now it's $520.
[AGENT][NEUTRAL] And this is it then. OK. All right, I found it.
[CUSTOMER][POSITIVE] Cause another, yeah, because we have you as secondary. Oh, OK, perfect.
[AGENT][NEUTRAL] Yeah, yes. All right. So this one was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it looks like all benefits payable was applied towards the calendar year deductible, so the 520 was applied towards the calendar year deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, for her deductible. OK, do y'all send something out to her to let her know that because she hasn't paid anything as of yet.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, um, when we process a claim we have the, um, you'll be going to the provider and a copy going to the member, so they are always not a fact when we process the claim.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, we didn't get that EOP as of yet. Does it usually take a couple of weeks or?
[AGENT][NEUTRAL] Uh, it really depends on the mail, but, but if you need to, yeah, it's back in May, it should have been there by now. Um, I can go ahead and fax a copy.
[CUSTOMER][NEUTRAL] That was in May.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Oh, perfect, yeah.
[AGENT][NEUTRAL] OK, what's the fax number?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] OK. [PII] to your attention or to what attention?
[CUSTOMER][POSITIVE] Yes, that'd be perfect. [PII]
[AGENT][NEUTRAL] So.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Great, uh, do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][NEUTRAL] Oh sure, yeah, I can hold.
[AGENT][POSITIVE] Thank you. All right, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for you Ms. [PII]. OK, I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] Uh, no, I was just wondering, uh, was the total deductible 520? Does that sound right?
[AGENT][NEUTRAL] The amount applied
[CUSTOMER][NEUTRAL] Or did y'all take some off?
[AGENT][NEUTRAL] No, the total amount applied towards the deductible was the 520.
[CUSTOMER][NEUTRAL] OK, just wanna make sure. Can I get a reference number for our call today?
[AGENT][NEUTRAL] Mhm. Yeah.
[AGENT][NEUTRAL] We don't have reference numbers so you can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] Oh, OK. Uh, how do you spell your name?
[AGENT][NEUTRAL] Sure, that's [PII] initial [PII].
[CUSTOMER][POSITIVE] OK, perfect. OK, thank you so much for all your help.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good afternoon, [PII].
[CUSTOMER][NEUTRAL] You too bye bye.