AccountId: 011433970860
ContactId: e886b1e2-1e52-4ae4-b685-5dd670a51644
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 215559 ms
Total Talk Time (AGENT): 66689 ms
Total Talk Time (CUSTOMER): 66589 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/e886b1e2-1e52-4ae4-b685-5dd670a51644_20250501T14:23_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um, I'm calling to follow up on a claim status.
[AGENT][NEUTRAL] Yeah, I could check on a claim for you. Uh, what was your name, please?
[CUSTOMER][NEUTRAL] [PII] and that's spelled [PII]
[AGENT][NEUTRAL] Got it. But you, is this for your policy, or are you with a provider?
[CUSTOMER][NEUTRAL] Provider.
[AGENT][NEUTRAL] OK and then can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] I do. It is 98. I'm sorry. It is 02337796.
[AGENT][NEUTRAL] Got it. And what was the name and date of birth for the member, please?
[CUSTOMER][NEUTRAL] [PII]. [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that [PII].
[AGENT][NEUTRAL] What was the date of service for this claim?
[CUSTOMER][NEUTRAL] It is a date range. It is [PII].
[AGENT][NEUTRAL] OK, do you have that bill amount?
[CUSTOMER][NEUTRAL] Um, total charges was $95,550.41.
[AGENT][NEUTRAL] OK, thank you. One moment please.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Uh, [PII], do you have the, uh, tax ID for this provider?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Do you happen to have that amount after major medical pay the remaining balance?
[CUSTOMER][NEUTRAL] Um, after the primary insurance?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The, uh, let's see, the left co-insurance of $2,247.25.
[AGENT][POSITIVE] OK, got it. I do believe I found it. Give me just a moment.
[AGENT][NEUTRAL] OK, so for this claim [PII] we paid a benefit of $66.03 and that did meet their maximum uh for their total inpatient benefit for the calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The so the inpatient benefits for the, OK, so the remaining goes to the patient.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] We don't say what is patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, [PII], thank you for your help. I appreciate it.
[AGENT][NEUTRAL] Sure, was there anything else I can help you with?
[CUSTOMER][NEUTRAL] No, ma'am, that was it.
[AGENT][POSITIVE] Alright, well thanks for giving us a call, [PII]. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] Thank you bye bye