AccountId: 011433970860
ContactId: e4c878af-4a47-436d-9b87-d64a6ad33bdf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 892940 ms
Total Talk Time (AGENT): 157041 ms
Total Talk Time (CUSTOMER): 181819 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/e4c878af-4a47-436d-9b87-d64a6ad33bdf_20250312T17:25_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][POSITIVE] Yes, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] from provider office. I want to know the claim status.
[AGENT][NEUTRAL] Sure, I can check on a claim for you. I'm sorry, what was your name?
[CUSTOMER][NEUTRAL] Yeah, and they one.
[AGENT][NEUTRAL] OK and then can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Wait a minute.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 001846260 M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] OK, thank you. And then, uh, what was the name and date of birth for the insured, please?
[CUSTOMER][NEUTRAL] There is a toilet.
[AGENT][NEUTRAL] Do you have the date of birth?
[CUSTOMER][NEUTRAL] Date of birth is uh.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, thank you for verifying that and then uh what was the date of service for this claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm sorry, that was [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what was that billed amount, please?
[CUSTOMER][NEUTRAL] $15,382 even.
[AGENT][POSITIVE] OK, thank you one moment please.
[AGENT][NEUTRAL] Um, so was that the amount before or after major medical paid?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] That amount, that 15,382, was that the amount before or after major medical paid?
[CUSTOMER][NEUTRAL] 2 minutes.
[CUSTOMER][NEUTRAL] Yeah, the, this amount is uh medical.
[AGENT][NEUTRAL] OK, um, do you have the tax ID?
[CUSTOMER][NEUTRAL] Yeah, yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I did find this claim, uh, we paid a benefit of $249.75.
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello. In this account, I'll check the previous history. Uh, you will be as in you will be, there is no costing 666 uh.
[CUSTOMER][NEUTRAL] Dollar 25 cents.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I, I don't know where you're getting that number, so I do see the total bill charges as $15,382 and then the amount that we paid was $249.75.
[CUSTOMER][NEUTRAL] Can you please tell me slowly? I'll note it down.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] What information did you need? I'm sorry?
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, what information did you need?
[CUSTOMER][POSITIVE] Yeah, I have you will you will be in this client.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What further information did you need from me?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yes, uh, I'm checking with the account. Can you please give me a moment?
[AGENT][NEUTRAL] OK, yeah, sure.
[CUSTOMER][POSITIVE] Thanks for your patience.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um, actually, uh, we received the will explanation of benefits. So I bought the claim regarding the claim paid and you're speaking this claim was paid and earlier.
[CUSTOMER][NEUTRAL] One person called to this insurance and stated the remaining balance, $666.25 was applied towards provider's write-off.
[AGENT][NEUTRAL] OK, um, we don't say what is patient responsibility, that would be up to the provider.
[CUSTOMER][NEUTRAL] OK. That would be provide a write off.
[AGENT][NEUTRAL] Whatever um patient responsibility is up to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And actually, we received the explanation of benefits and stating the claim paid information. But uh you are stating that remaining balance was applied to us providers or as patient responsibility that is not mentioned in the EOB.
[AGENT][NEUTRAL] Right, because we don't say what is patient responsibility, we simply say the benefit amount that we paid.
[CUSTOMER][NEUTRAL] Can you confirm the
[CUSTOMER][NEUTRAL] OK. Can you please confirm the uh claim number?
[AGENT][NEUTRAL] Uh, sure, that claim number is 352-6304.
[CUSTOMER][NEUTRAL] 304.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] In this claim form, you have you have not mentioned this on the patient responsibility.
[AGENT][NEUTRAL] Because we do not say what is patient responsibility that is up to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you please give me a moment?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um, actually, mm, is there any updated EOP other than this claim form, a claim number which you have stated now?
[AGENT][NEUTRAL] Um, no, I, I'm not quite sure, but you have, but if you'd like, I can send you this copy, but, um, it's going to be the same as that you received.
[CUSTOMER][NEUTRAL] Uh, OK. Can you please send me the, uh, can you please fax the UOB for us again?
[AGENT][NEUTRAL] Sure, uh, what was that fax number for you?
[CUSTOMER][NEUTRAL] OK, fax number.
[CUSTOMER][NEUTRAL] The fax number is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello
[AGENT][POSITIVE] All right. I will go ahead and get that sent to you. You should get it here in within 1015 minutes. Was there anything else I could help you with?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Can you please check the another claim?
[AGENT][NEUTRAL] Oh, is this for the same member?
[CUSTOMER][NEUTRAL] Different number.
[AGENT][NEUTRAL] OK, give me just a moment. um I'm gonna get sent this uh EOB and then I'll let you know when I'm ready.
[CUSTOMER][NEUTRAL] OK, then you can tell me the call reference for this account.
[AGENT][NEUTRAL] Reference number would be the same for either, uh, for any that we check. It would be my first name, last initial, and today's date. Uh so my name is spelled [PII]
[CUSTOMER][POSITIVE] OK thank you.
[AGENT][NEUTRAL] Of course. All righty. One moment, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK. Appreciate your patience. Uh, you can go ahead and give me that next policy number.
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yes, wait a moment. I will check it.
[CUSTOMER][NEUTRAL] The policy number is 0228617 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Are you there?
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] I don't.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] go
[CUSTOMER][NEUTRAL] That is and wait.