AccountId: 011433970860
ContactId: edbcddb0-16fe-49ff-bb1c-84f89c1effad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 586130 ms
Total Talk Time (AGENT): 201879 ms
Total Talk Time (CUSTOMER): 144144 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/2025/02/04/edbcddb0-16fe-49ff-bb1c-84f89c1effad_20250204T14:51_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling from BMC Atala to check on our claim status. Could you please help me with that?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] You said, oh, I'm sorry, I hit the wrong button. You said to check on claim status.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and may I have your name again?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. Uh, it's [PII].
[AGENT][NEUTRAL] And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] I have only one.
[AGENT][NEUTRAL] OK, may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. It's 02030115.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, sure. The number first name is [PII] and the last name is [PII].
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] 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. May I have the date of service for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Sure, it's number [PII] and the total bill amount is $2,383 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it's OK if I place you on a brief hold while I take a look for the claim?
[CUSTOMER][POSITIVE] Yes, sure. Take your time.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEGATIVE] I'm about to be yawning in my ear. That's rude.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] You can on to the whole music 375.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes, I'm here.
[AGENT][POSITIVE] Thank you so much for holding. Can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yeah, sure. It's BMC Atala.
[AGENT][NEUTRAL] OK, so I'm showing we received the claim on [PII].
[CUSTOMER][NEUTRAL] Yes. It's number 2.
[AGENT][NEUTRAL] That claim
[AGENT][NEUTRAL] I'm giving you the date that the
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm giving you the date the claim was received.
[CUSTOMER][POSITIVE] OK, sorry for that. OK.
[AGENT][NEUTRAL] OK. It's [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 353.
[AGENT][NEUTRAL] 5872.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim to the provider.
[AGENT][NEUTRAL] A total of $703.19.
[AGENT][NEUTRAL] That was sent with a single check. Did you need that check information?
[CUSTOMER][NEUTRAL] Yes. Can I get the check number?
[AGENT][POSITIVE] Yes, I'm going to give you the check information. Are you ready?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The check number is 2016233.
[AGENT][NEUTRAL] It was issued on [PII].
[AGENT][NEUTRAL] It was a single check in the amount. Oh, hold on one second. That's not right. Hold on one moment.
[AGENT][NEUTRAL] 201.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] Um, OK, so 2016223 is the check number. It was issued on [PII].
[AGENT][NEUTRAL] In the amount of $703.19 and it cleared on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment please.
[CUSTOMER][NEUTRAL] OK. Upon checking here, uh, I have the paid EOB but we have an um balance amount. It's $89 even.
[CUSTOMER][NEUTRAL] Our expected amount is
[CUSTOMER][NEUTRAL] $792.19.
[CUSTOMER][NEUTRAL] Upon checking here, the admission type is emergency. So,
[CUSTOMER][NEUTRAL] Uh, may I know why it is fully paid?
[AGENT][NEUTRAL] Are you wanting to know what to do with the balance?
[AGENT][NEUTRAL] OK, hold on one moment. Let me see.
[CUSTOMER][NEUTRAL] Yeah, uh,
[AGENT][NEUTRAL] Is there a policy?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] OK, there's a deductible for outpatient of $100 per calendar year, so the remainder was applied to the deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so the annual deductible is uh 100, right?
[AGENT][NEUTRAL] Right, the outpatient calendar year deductible is $100 per calendar year.
[CUSTOMER][NEUTRAL] And so far, uh how much patient met?
[AGENT][NEUTRAL] OK, we don't give all this information to the providers. Let me see, hold on one second.
[CUSTOMER][NEUTRAL] OK. Uh.
[AGENT][NEUTRAL] Yeah, that's not really providing information. That's more about the patient's policy, but of your balance, the $703.19 was paid to the provider, the remainder was paid to the deductible.
[CUSTOMER][NEUTRAL] OK, just a moment please.
[CUSTOMER][NEUTRAL] Uh, could you please send me the copy of the EB?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] Just a moment. It's
[CUSTOMER][NEUTRAL] It's 833.
[CUSTOMER][NEUTRAL] 826
[CUSTOMER][NEUTRAL] 684 3.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] All right, so I'll go ahead and send the explanation of benefits over to you now. Was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Um, now that's it for today. Can I get the call reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. And again, that's [PII] The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK, and may I know when will I receive the EOB?
[AGENT][POSITIVE] Um, I'm sending it to you now. Usually with faxes, you got to give it at least an hour. Um, if you haven't received it by the end of day today, you can definitely give us a call and we'll be more than happy to send it again for you.
[CUSTOMER][NEUTRAL] OK. Could you please send to the attention to my name, [PII]?
[CUSTOMER][NEUTRAL] Use my name as.
[AGENT][NEUTRAL] Yes, I sent it to [PII] attention [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much for assisting me today. And uh, have a wonderful day. Bye for now.
[AGENT][POSITIVE] You also, and thanks for calling APL. Thank you. Bye-bye.