AccountId: 011433970860
ContactId: eee1ac41-1138-410a-bee8-0e5878f21ba2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 375679 ms
Total Talk Time (AGENT): 164887 ms
Total Talk Time (CUSTOMER): 164458 ms
Interruptions: 6
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/eee1ac41-1138-410a-bee8-0e5878f21ba2_20250618T19:24_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], and I am calling from the provider's office. I have a claim on a patient. I need to check on, please, um.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, [PII], so you're needing check claim status for a member, is that correct? Yes, ma'am. Oh.
[CUSTOMER][NEUTRAL] Yes, well, I need to check if the patient is responsible for the balance because my claim paid but it didn't pay very much and.
[CUSTOMER][NEUTRAL] So, can you look at it, please?
[AGENT][NEUTRAL] OK. Well, I can, I can certainly um take a look at this for you and help you with this. What is your callback number, please, [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] 01279925
[AGENT][NEUTRAL] OK, thank you, one moment while I get the member's information pulled up.
[AGENT][NEUTRAL] OK, [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth, please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So I had called on this previously and spoke to [PII] and she got the payments reissued for me. They were paid on two separate checks, but um the bill amount is $5,691 and the two people.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes, I am.
[AGENT][NEUTRAL] All right, one just, alright, let's see. Whoops, hold on one second. Well, so give me the date of service first.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and the total bill amount one more time.
[CUSTOMER][NEUTRAL] 5,691
[AGENT][NEUTRAL] OK, and so this was submitted as one claim or two claims?
[CUSTOMER][NEUTRAL] Well, it was submitted as one claim but it paid on two different, um, she had told me that one paid on a um indemnity policy and one on a high, um.
[AGENT][NEUTRAL] Because you
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] An HI policy. I'm not sure what the HI is, but so it paid on two separate payments, yeah, so it was 650.
[AGENT][NEUTRAL] That's a hospital indemnity.
[AGENT][NEUTRAL] OK, now, this policy number you gave me is a dental policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The policy number you just gave me is a, is this for a dental claim?
[CUSTOMER][NEUTRAL] No, it's not. It's an accident claim and I don't know. Let me get the remit and see.
[AGENT][NEUTRAL] Um, OK, so that's
[CUSTOMER][NEUTRAL] It's 01288298.
[AGENT][NEUTRAL] Let me get the right policy pulled up because, yeah, that first policy number pulled up everything was um dental.
[CUSTOMER][NEUTRAL] OK. Sorry, I think I, I think we did that before when I called the last time too.
[AGENT][NEUTRAL] Yeah, just, just wipe that one off of your
[CUSTOMER][NEUTRAL] So is that one that ends in 298 the right number?
[AGENT][NEUTRAL] Information.
[AGENT][NEUTRAL] Uh, give me, uh, just a second. That's gonna be the group accident policy.
[AGENT][NEUTRAL] That's what that one is on the one ending 01.
[CUSTOMER][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] 288298 is the group accident policy.
[CUSTOMER][NEUTRAL] OK, and the one that ends in 297 must be the indemnity.
[AGENT][NEUTRAL] And I'm
[AGENT][NEUTRAL] Still not looking at that one, yeah.
[AGENT][NEUTRAL] OK, so is the claim, OK, so are you're trying to determine pay you, OK, wait a minute, let's not, and we don't determine patient responsibility here at APL. That would be up to the provider.
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] Patient responsibility.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] So you don't provide a discount or anything on the process claim, you just pay that, that amount, OK, so the patient's gonna be responsible for that balance. I just wanted to make sure before I sent them a statement.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, ma'am. We do not, right. We do, we do not determine patient responsibility.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, alright, um, no provider adjustment.
[CUSTOMER][NEUTRAL] So, um, can I get a call reference number?
[AGENT][NEUTRAL] Oh, yes, ma'am. You would use my name along with today's date. And do you already have the claim numbers, [PII]?
[AGENT][NEUTRAL] For this state of service, OK. So yes, ma'am, um, and if you were to need a copy of the explanation of benefits or for the just for future reference, once we have processed the claim here at APL, we have a portal and [PII] may have given you that information. Did she already tell you about our portal?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I've got, uh, well, it came through our um intermediary, so I got it, so yeah, I got both of them.
[AGENT][NEUTRAL] The secured
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Secured. [PII] is for, yes, it's for claim status.
[CUSTOMER][POSITIVE] OK. OK. All right. Well, thank you so much. I appreciate it. I hope you have a good afternoon.
[AGENT][NEUTRAL] Alright.
[AGENT][POSITIVE] OK. Oh, well, I hope you have a nice afternoon too, and if that is all I can help you with one, it was my pleasure in speaking to you today and thank you again for calling.
[CUSTOMER][POSITIVE] Thank you. Mhm. Bye-bye.
[AGENT][NEUTRAL] Yes, ma'am.