AccountId: 011433970860
ContactId: ef52e415-bf06-44ed-8820-cd5590f74ded
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 613820 ms
Total Talk Time (AGENT): 158306 ms
Total Talk Time (CUSTOMER): 175085 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/ef52e415-bf06-44ed-8820-cd5590f74ded_20250521T17:58_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office to check on a claim status.
[AGENT][NEUTRAL] Hey [PII], I can help you with claim status. Can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] My callback number is [PII].
[AGENT][NEUTRAL] I'm sorry, can I get, I have [PII] and what were the last four?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] I mean
[CUSTOMER][NEUTRAL] The policy number.
[CUSTOMER][NEUTRAL] Just give me one second. The policy number is 02563741.
[AGENT][NEUTRAL] One moment while I look that up for you, [PII].
[CUSTOMER][NEUTRAL] OK. Can you please spell your name?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] And can you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name is [PII], and the date of birth is [PII].
[AGENT][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] And do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] Yes, I have a date of service and bill amount. The date of service is [PII]. The total bill amount is $126 even.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right, one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Would you like the claim number for this?
[CUSTOMER][NEUTRAL] Hello
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It's 355.
[AGENT][NEUTRAL] 29 0 go ahead.
[CUSTOMER][NEUTRAL] Sorry, uh, sorry for that, um, hello.
[CUSTOMER][NEGATIVE] So I have provided the wrong date of service. The date of service is [PII]. The total bill amount is $189 even.
[AGENT][POSITIVE] OK, I'm so sorry, can you start that over?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Sure, the date of service is [PII]. The total bill amount is $189 even.
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][NEUTRAL] OK. Sorry for the inconvenience.
[AGENT][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] Oh my [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, the claim number for this is 35.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] 36.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 38.
[AGENT][NEUTRAL] 3.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] OK, and give me just a moment while I look up the rest.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It looks like we received this claim on [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it looks like this was paid.
[CUSTOMER][NEUTRAL] Pa.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Can I get the pay details?
[AGENT][NEUTRAL] It looks like it was paid $50.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] It looks like it was paid $50 because with this check, the maximum benefit payable for that date of service has been met.
[CUSTOMER][NEUTRAL] in
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Oh yeah, maybe some.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else?
[CUSTOMER][NEUTRAL] Paid amount is $50 right?
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] Yeah, but uh
[CUSTOMER][NEUTRAL] But we have
[CUSTOMER][NEUTRAL] The the U be in that I mentioned.
[CUSTOMER][NEUTRAL] There is no payment was made for this claim. Uh, the reason code we have received is 23 which is impact of pay pay adjudication.
[AGENT][NEUTRAL] It it looks like the charge is $189 and we paid $50 towards that because they met their maximum for the for that day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, may I know this is a dual plan or uh?
[AGENT][NEUTRAL] So that's why only partial was paid.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] This is the dual plan or?
[CUSTOMER][NEUTRAL] Something else.
[AGENT][NEUTRAL] It's a hospital indemnity plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you please send us in UB through fax?
[AGENT][NEUTRAL] Sure, what's a good fax number?
[CUSTOMER][NEUTRAL] Just give me 1 2nd.
[CUSTOMER][NEUTRAL] The fax number is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, I have [PII], correct?
[CUSTOMER][POSITIVE] Yeah, yeah, that's correct.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know whether it was paid through check or EFT?
[AGENT][NEUTRAL] Uh, it was through check.
[CUSTOMER][NEUTRAL] Check.
[CUSTOMER][NEUTRAL] Can I get the check number?
[AGENT][NEUTRAL] 201.
[AGENT][NEUTRAL] 68.
[AGENT][NEUTRAL] 87.
[CUSTOMER][POSITIVE] You too, got it.
[CUSTOMER][NEUTRAL] This is a bulk payment or a single payment?
[AGENT][NEUTRAL] Uh, this was a partial payment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you please provide me the check issue date?
[AGENT][NEUTRAL] Oh, sure. Give me just a moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Alright, give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, give me just a second.
[AGENT][POSITIVE] The check went is, the check has cleared.
[AGENT][NEUTRAL] It looks like it was issued on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It cleared on [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK, OK, that's it for this claim.
[CUSTOMER][NEUTRAL] You said you are the primary for this member, right?
[AGENT][NEUTRAL] Um, this would be a secondary insurance. It's a hospital indemnity plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know which is the primary insurance for this number?
[AGENT][NEUTRAL] We don't have any major medical.
[AGENT][NEUTRAL] I'm sorry, what?
[CUSTOMER][NEUTRAL] May I know which is the primary insurance for this member?
[AGENT][NEUTRAL] Oh, give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] the
[AGENT][NEUTRAL] I don't see that, so this might be the only one that they have this person has.
[CUSTOMER][NEUTRAL] OK, got it. Uh, that's it for this claim.
[CUSTOMER][NEUTRAL] Can I get the call reference number?
[AGENT][NEUTRAL] Sure, it's my first name and last initial, so [PII], H as in hospital, and then today's date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] That's it. Thank you so much for providing all the information. Have a wonderful day.
[AGENT][POSITIVE] OK, thank you for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Yeah thank you bye.
[AGENT][NEUTRAL] Bye.