AccountId: 011433970860
ContactId: e395b0a8-a442-4a0b-bfec-4452e534b8ab
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1151369 ms
Total Talk Time (AGENT): 296724 ms
Total Talk Time (CUSTOMER): 325454 ms
Interruptions: 6
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/e395b0a8-a442-4a0b-bfec-4452e534b8ab_20250619T17:24_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from provider's office, checking on a claim status. How are you doing today?
[AGENT][POSITIVE] I'm good, [PII]. How are you doing today?
[CUSTOMER][POSITIVE] Yeah, I'm doing great as well thank you for asking, by the way.
[AGENT][NEUTRAL] Good, so you said that you have one claim that you're needing to check status on, is that correct?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][POSITIVE] Yes, I can help you with that. And [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] Gosh, it's [PII] with an extension of [PII].
[AGENT][NEUTRAL] Thank you. And what is the member's policy number, please?
[CUSTOMER][NEUTRAL] It's 025652227.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] And any information [PII] that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name was [PII], and the date of birth was [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] Data service was [PII] and the bill amount was $4,611 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] You left me here.
[AGENT][NEUTRAL] OK, so this claim was received. It was received on [PII]. It was processed on [PII].
[AGENT][NEUTRAL] The claim number is 3613455.
[AGENT][NEUTRAL] There was a benefit paid in the amount of $228.50.
[AGENT][NEUTRAL] And the remarks.
[CUSTOMER][NEUTRAL] 50.
[CUSTOMER][NEUTRAL] 50, right?
[AGENT][NEUTRAL] 502-28.50
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on code 43249 $190.13 was paid.
[AGENT][NEUTRAL] And on code 43239 $38.37 was paid, and on that code, the remark states with the payment of this check, the policy maximum for this benefit has been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just just give me a minute.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And these were any patient responsibility?
[AGENT][NEUTRAL] We do not determine patient responsibility. That would be up to the provider, [PII].
[AGENT][NEUTRAL] And there should there will be an EOB along with the check that was mailed. However, you may also print it.
[CUSTOMER][NEUTRAL] OK. Well, in that case,
[AGENT][NEUTRAL] From our portal if you go to [PII].
[CUSTOMER][NEUTRAL] Uh, while I'm back.
[CUSTOMER][NEUTRAL] Secure. just give uh just, would you spell that for me? [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, the first word is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][POSITIVE] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] It's secure.
[AGENT][POSITIVE] With the, yeah, secured.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, I do have access for this, but I'm trying to search the claim, but I don't, uh, I'm not getting any info out of this as it was asking the patient's SSN number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] To generate our
[AGENT][NEUTRAL] Yes, but what you don't have to, yes, sir, but now that you have the claim number, you should not need that.
[CUSTOMER][NEUTRAL] Oh, well, in that case, just give me a minute.
[AGENT][NEUTRAL] Uh-huh, sure.
[CUSTOMER][NEUTRAL] Let me confirm the claim number once again. It's 361-345-5.
[AGENT][POSITIVE] Yes sir, that is correct, that is correct.
[CUSTOMER][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] OK, bear with me. I'm checking with checking your.
[AGENT][NEUTRAL] Oh yeah, sure.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And once again, what's the paid amount that you have mentioned earlier?
[AGENT][NEUTRAL] The benefit paid was $228.50.
[CUSTOMER][NEUTRAL] Oh, does it process as primary or secondary?
[AGENT][NEUTRAL] This is the supplemental policy. We are not a major medical insurance, so we would not be a primary.
[CUSTOMER][NEUTRAL] So, uh, as for checking in my system, the balance is $229.50 or 18 cents.
[CUSTOMER][NEUTRAL] And from in that.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh, there's $55 of patient responsibility. That means the total balance that I
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] And we do not determine, yes, sir, but we, we do not determine that. That would be up to the provider.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But here, upon checking, uh I think you have paid. So.
[CUSTOMER][NEUTRAL] Extra, I think.
[AGENT][NEUTRAL] No, sir.
[AGENT][NEUTRAL] This policy helps with the co-pays, deductibles and co-insurance amounts of covered services.
[CUSTOMER][NEUTRAL] So for this policy, the patient, uh for the, this is the, so last uh benefit that the patient has used, right? I mean, utilized.
[AGENT][POSITIVE] That is, that is correct.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] That claim remark, yes. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] But as for now, I think you have paid an extra amount with us.
[CUSTOMER][NEGATIVE] Yeah, that's the only thing that's bothering me. It's um um so.
[AGENT][NEUTRAL] OK, if you look on the explanation of benefits, you need to look at the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Mm, I already, I got that.
[AGENT][NEUTRAL] And I'm looking at what was submitted with this claim.
[CUSTOMER][NEUTRAL] Mm, oh, OK. If you got the primary EOB, would you mind verify the claim number for me once again?
[AGENT][NEUTRAL] Uh, not for the primary insurance company's explanation of benefits.
[AGENT][NEUTRAL] Because you all file a claim, you would have to.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] No, I can't do that.
[CUSTOMER][NEUTRAL] OK. But, but I'm uh saying you, there are $229.18.
[CUSTOMER][NEUTRAL] $229.18 were left and you'll pay $228.50.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] I'm not understanding what's happening.
[AGENT][NEUTRAL] Just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So what was left was 22918.
[AGENT][NEUTRAL] According to the primary insurance EOB and we paid 228.50.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] $12 discount then.
[CUSTOMER][NEUTRAL] Sorry, uh, would you mind to repeat that?
[AGENT][NEUTRAL] This primary EOB shows 22918 and this claim that we processed, we processed for 228.50.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, there is a shortage of 68 cents.
[AGENT][NEUTRAL] OK, so what I can do, I, I will send this claim back to have it uh reviewed again if you would like for me to do that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh yeah, please, go ahead. Uh, I think, uh, just give me a minute.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, sir. And it's still here, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, thank you [PII] for being patient, being patiently for me online. Yeah, I've got that. Uh, may I know how the payment was processed?
[AGENT][POSITIVE] Mhm. Yeah, you're welcome.
[AGENT][NEUTRAL] A single check.
[CUSTOMER][NEUTRAL] Single check. And uh can I have the check number?
[AGENT][NEUTRAL] 2050178.
[CUSTOMER][NEUTRAL] 2050178. That's correct?
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] And it was issued on [PII], the same date as the process date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, payment process. Let me check. OK.
[CUSTOMER][NEUTRAL] OK, maybe the, the, the 68 cents were exhausted due to the maximum benefits exhausted by of the patients. Maybe that 68 will go to the patient responsibility, I think.
[AGENT][NEUTRAL] OK, so do you want me to have it sent back for reprocessing for review?
[CUSTOMER][NEUTRAL] Mm, no.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] That where in the, the UB that I have downloaded. And you have mentioned me, right? Remark code P2E0013. The pay with the payment of this check, the policy maximum for this benefit has been met, right?
[AGENT][POSITIVE] That is, that is correct.
[CUSTOMER][NEUTRAL] Yeah, well, well, I say that's the case.
[AGENT][NEUTRAL] But I am, yes.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, well, if that's the case, the 68 cents will be the patient's responsibility. So, uh, there's no need of uh.
[CUSTOMER][NEUTRAL] Uh, sending claim back for review, um, I'm fine with that.
[AGENT][NEUTRAL] OK, alright, so one moment please.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] $20.
[CUSTOMER][NEUTRAL] But it's not there.
[AGENT][NEUTRAL] And you were able to access the EOB, [PII]?
[CUSTOMER][NEUTRAL] Uh, actually, uh, the, you, it says actually no this is not a bill, yeah, I've downloaded it from the website through your guidance.
[AGENT][NEUTRAL] Yes, so that's what I mean you were able, yes you were able to download it.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][POSITIVE] OK, good.
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK. So is there anything else that I could help you with?
[CUSTOMER][NEUTRAL] Actually
[CUSTOMER][NEUTRAL] Um, yeah, that's nothing much. That's all my questions were answered now answered, and there's nothing else.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, well, if that is all that I can help you with, you're welcome, [PII] and thank you for calling APL and I hope you have a nice rest of your day.
[CUSTOMER][POSITIVE] Thank you, [PII].
[CUSTOMER][NEUTRAL] And car reference number, please?
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That's great. [PII], and the initials of your last name?
[AGENT][NEUTRAL] [PII] and yours?
[CUSTOMER][NEUTRAL] Um, mine was [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right, [PII]. Well then, if, yes, you're very welcome. And again, have a great afternoon. The rest of your day.
[CUSTOMER][POSITIVE] OK. Thank you, [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Uh-huh. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.