AccountId: 011433970860
ContactId: e9edd6aa-074c-4f20-97e8-745f28124c11
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 831109 ms
Total Talk Time (AGENT): 172145 ms
Total Talk Time (CUSTOMER): 229752 ms
Interruptions: 4
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/e9edd6aa-074c-4f20-97e8-745f28124c11_20250331T13:58_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling for provider office to check on a claim status.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status. You say your name is [PII]?
[CUSTOMER][NEUTRAL] Uh, [PII]
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Uh, could you please spell your name for me?
[AGENT][NEUTRAL] And may I have a callback number just in case?
[AGENT][NEUTRAL] Sure. That's [PII]. That's initial [PII].
[CUSTOMER][POSITIVE] Mhm, thank you for that and the callback number is [PII].
[AGENT][POSITIVE] You're welcome. May I have
[AGENT][NEUTRAL] Mhm. Go ahead.
[CUSTOMER][NEUTRAL] Oh sure, [PII] that's the direct line.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what's the name of the facility you're calling from from my location?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sure. It's uh Crystal Santa Rosa Hospital.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] That is 023 05575.
[AGENT][NEUTRAL] All right, thank you. One moment, let me pull this information.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] And patient name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's [PII] for the total bill amount of $2520 even.
[AGENT][NEUTRAL] OK, so that's [PII] for 2520.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, for future, you can check claim status online through our website at [PII] and that's just optional. And it looks like we send the payment of $50. That is the maximum benefit for the.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] ER visit. That's the maximum payable under this policy for an ER visit.
[CUSTOMER][NEUTRAL] Oh, OK. uh, what's the receipt date of the claim?
[AGENT][NEUTRAL] Um, let me check when we received it. One moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It was received [PII], processed [PII].
[CUSTOMER][NEUTRAL] [PII] and [PII], right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Can I get the claim number for this?
[AGENT][NEUTRAL] Sure, the claim number is 3,389,030.
[CUSTOMER][POSITIVE] OK. Thank you for that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Just one moment. Uh, could you please repeat the, uh, claim denial reason one more time?
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] Uh, it was not denied. It was paid. We pay $50 which is the maximum payable under this policy for an ER visit.
[CUSTOMER][NEUTRAL] Mhm. Um, may I know uh the remaining balance is going to be the member responsibility or the provider I told?
[AGENT][NEUTRAL] It's up to the provider's discretion. We don't have any contractual involvement in the remaining of the claim.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm. Well, uh,
[CUSTOMER][NEUTRAL] Uh, can I get the EFT number or the check number for the payment?
[AGENT][NEUTRAL] Yes, I can give you the check number. Um, let me see.
[AGENT][NEUTRAL] That is check number 1823643.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Thank you for that. What's the issued and clear date of the check?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, I'll have to get that information that's not here. Um, do you mind holding for me while I search for that information?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold.
[CUSTOMER][NEUTRAL] OK
[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 me, Ms. [PII]. OK, this check cleared on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] What's the issue date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] You shouldn't clear it, right?
[AGENT][NEUTRAL] That the, that is the clear date. The clear date was [PII]. The process date or the issue date is [PII].
[CUSTOMER][NEUTRAL] OK. Uh, could you please check, uh, whether it is a single amount or by check amount?
[AGENT][NEUTRAL] This is Sing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Mhm. Thank you for that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can I get the call reference number for this call?
[AGENT][NEUTRAL] We don't have reference numbers, you can use my name in today's date.
[CUSTOMER][POSITIVE] Mhm. OK. Thank you so. Thank you for assistance. Have a good day. Take care. Bye-bye.
[AGENT][POSITIVE] You're welcome. You're as well. Thank you for calling ATM. Bye bye.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Um, I want one more question on this. Um, could you please check whether there is any member responsibility on this?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We don't have any contractual involvement on the remaining of the claim, and this is not a major medical.
[CUSTOMER][NEUTRAL] Mhm. No member responsibility, right?
[AGENT][NEUTRAL] Again, we cannot make that decision for the provider. It's up to the provider's discretion. This is not a major medical.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This is a limited policy.
[CUSTOMER][POSITIVE] OK, thank you for that. Um,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Could you please fax a copy of EOB?
[AGENT][NEUTRAL] What is the fax number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's 3 consecutive 8.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] There
[CUSTOMER][NEUTRAL] uh
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] It's gonna be one more minute. I'm trying to send her while I got you on the line.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Who make it in there.
[AGENT][NEUTRAL] Is it gonna be to your attention?
[AGENT][NEUTRAL] Miss [PII].
[CUSTOMER][NEUTRAL] Yes, yes, [PII]
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I know.
[AGENT][POSITIVE] OK, I went ahead and send that over to you. Is there anything else I'm gonna help you with today?
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] What's the turnaround time for the EOB?
[AGENT][NEUTRAL] A few minutes.
[CUSTOMER][POSITIVE] Mhm. OK. Thank you for that. Uh, thank you for your assistance. Have a good day. Take care. Bye-bye.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes sir, thank you for calling APL. Bye bye.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Yeah