AccountId: 011433970860
ContactId: ee664f7a-797d-455e-8a9f-11f2514866a2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 308529 ms
Total Talk Time (AGENT): 87544 ms
Total Talk Time (CUSTOMER): 138670 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/ee664f7a-797d-455e-8a9f-11f2514866a2_20250108T13:34_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII]. I'm calling for uh claims.
[AGENT][NEUTRAL] I can help you, [PII]. What's the policy number?
[CUSTOMER][NEUTRAL] Policy number is.
[CUSTOMER][NEUTRAL] Just 02792137.
[AGENT][POSITIVE] And a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And the patient's name and date of birth? Uh-huh.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Can you repeat the policy number?
[CUSTOMER][NEUTRAL] 02792137
[AGENT][NEUTRAL] Do you have a copy of the card?
[CUSTOMER][NEUTRAL] Uh, hold on.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, no, sorry. We do not have the, uh, the copy of the card. Last name?
[AGENT][NEUTRAL] Spell the
[AGENT][NEUTRAL] Spell the patient
[AGENT][NEUTRAL] Spell the patient's first and last name for me? Mhm. First and last.
[CUSTOMER][NEUTRAL] OK, sure. First name is uh [PII] Last name is [PII], [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what state does the patient reside?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Uh, no, sorry.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] the state of [PII].
[CUSTOMER][NEUTRAL] Yes, uh, but the, uh, service was rendered in [PII].
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And are you a dental or medical provider?
[CUSTOMER][NEUTRAL] Medical.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that information, [PII]. The policy number is 024.
[AGENT][NEUTRAL] 92137.
[CUSTOMER][NEUTRAL] Uh, OK, so it's one digit off.
[AGENT][NEUTRAL] Mhm 024 instead of 027. Mhm. And you you said that you're checking a claim status?
[CUSTOMER][NEUTRAL] Instead of 027.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Yeah, actually, we already received uh an ELB. I have a claim number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's 394-445-9.
[CUSTOMER][NEUTRAL] I just have a question how the claim was uh processed.
[AGENT][NEUTRAL] OK, and what is your question?
[CUSTOMER][NEUTRAL] Yeah, uh, this claim is actually billed for $3,649 but on the EOB that we receive, it shows that it was only processed for $2,088 wherein you paid $450 and the rest of the amount was applied as contractual adjustment which is $1,638.
[AGENT][NEUTRAL] OK, so on the remark code, on the remark code on the ELB it says with this check, the maximum benefit payable for this date of service has been met, so that's the maximum benefit payable.
[CUSTOMER][NEUTRAL] So, I'm just
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Oh, OK, nothing benefit has been met, uh, because it's not on the, uh, EOB that we received, just the, uh.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] It's on the back of the ELB.
[CUSTOMER][NEUTRAL] The contract. Oh, OK.
[CUSTOMER][NEUTRAL] Alright, so that amount, the difference would be, uh, it's not patients responsibility, right?
[AGENT][NEUTRAL] We do not determine patients responsibility.
[CUSTOMER][NEUTRAL] OK, so we cannot bill the patient for the amount. Alright, thank you, uh, [PII].
[AGENT][NEUTRAL] We cannot advise. Yeah. Any other questions? I, OK. Any other questions, [PII]?
[CUSTOMER][NEUTRAL] Uh, OK, I understand. No, that's it. Just a reference number, uh, just a reference number, please.
[AGENT][NEUTRAL] You'll use my
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] You'll use my name in today's date as reference for today's call. [PII].
[AGENT][NEUTRAL] Oh NYA first initial last name is [PII] and any other questions?
[CUSTOMER][POSITIVE] Oh no, that's it thank you.
[AGENT][POSITIVE] Alright, and you can also check your status on our online service center at [PII]. And if no other questions, [PII], thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Yeah you too thank you bye bye.
[AGENT][NEUTRAL] Bye-bye.