AccountId: 011433970860
ContactId: e4245ea3-428d-4eca-ab09-b1b56b2c5653
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 344290 ms
Total Talk Time (AGENT): 139697 ms
Total Talk Time (CUSTOMER): 135675 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/e4245ea3-428d-4eca-ab09-b1b56b2c5653_20250317T19:30_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] Hello [PII]. My name is [PII] calling for the provider Summit Medical Group to check on a claim status. Please be informed that this call has been recorded and monitored for quality and training purposes. And may I know if I can help with the patient's information, the provider's information, please?
[AGENT][NEUTRAL] So, may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. It's [PII]. My extension is a direct line.
[AGENT][POSITIVE] Thank you for that, and I'll be more than happy to help you with the claim status. May I have the member's policy number?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yes, it's 01660290 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] Yes, it's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim you like me to check on and the total bills?
[CUSTOMER][NEUTRAL] Yes, the date of service is [PII].
[CUSTOMER][NEUTRAL] And total bill amount is.
[CUSTOMER][NEUTRAL] Yeah, I do have a text number.
[CUSTOMER][NEUTRAL] Just a moment please. Yes, it's $67 even.
[CUSTOMER][NEUTRAL] I want to make sure that the area.
[AGENT][NEUTRAL] $67 even?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Everything that you have.
[AGENT][NEUTRAL] And again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment while I locate the claim for you.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Alright, so I'm showing we received the claim on [PII].
[AGENT][NEUTRAL] Claim number is 3574889.
[AGENT][NEUTRAL] And on [PII], the claim was paid out onto the provider, a total of $11.31.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the claim is paid on [PII]?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. The claim is paid, just a moment.
[CUSTOMER][NEUTRAL] So may I know the process date, please?
[CUSTOMER][NEUTRAL] Is it the same as the pay date?
[AGENT][NEUTRAL] Yeah, there was
[AGENT][NEUTRAL] Yes, it was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And may I know the allowed amount? Is it $11.31?
[AGENT][NEUTRAL] Let me see, hold on one moment.
[AGENT][NEUTRAL] Yes, um, because we paid what was billed in full. 87086 was billed $5.65. 87088 was billed $5.66.
[CUSTOMER][NEUTRAL] OK. Thank you so much for the information. So in total, it's $11.31 right? No patient responsibility. And may I know the mode of payment? Yes.
[AGENT][NEUTRAL] Hold on, hold on, hold on. So we don't determine patient responsibility. So if there is an outstanding balance, that would be up to the provider to determine next steps.
[CUSTOMER][NEGATIVE] But right now there is no patient responsibility, right?
[CUSTOMER][NEUTRAL] As I can see, the allowed amount is the same as the paid amount.
[CUSTOMER][NEUTRAL] This.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So if the total bill was 67 and we paid 11, there is a, there is an outstanding balance. There's we just don't determine remaining balance, um, or we don't determine patient responsibility. So if there is a remaining balance, that would be up to you. That wouldn't come from APL, which is why it's not on the explanation of benefits.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK. So may I know the allowed amount once again, please?
[AGENT][NEUTRAL] When you ask for the allowed amount, are you saying the allowed amount for the benefit used?
[AGENT][NEUTRAL] Because we're the, what do you mean the allowed amount?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I, uh, for this claim, may I know how much allowed amount is there? Because, yes, the total charges are 67, but
[CUSTOMER][NEUTRAL] As per the American Public Life Insurance Company, what is the allowed amount for this patient?
[AGENT][NEUTRAL] So the allowed amount for the benefit that was used was outpatient, which is $5000 per calendar year. That's what's allowed.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] In terms of your claim and asking if there's a remaining balance, the total bill was 67 and we paid 11, so there is a remaining balance, but we don't determine patient responsibility, so that remaining balance would be
[CUSTOMER][NEUTRAL] Just a moment, please.
[AGENT][NEUTRAL] Um, up to you to decide how as the
[AGENT][NEUTRAL] As a provider, not you personally.
[CUSTOMER][NEUTRAL] OK, just a moment, please.
[AGENT][NEUTRAL] OK.