AccountId: 011433970860
ContactId: fcff0326-dd9f-403c-b34c-2270a3d8863f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 605000 ms
Total Talk Time (AGENT): 251173 ms
Total Talk Time (CUSTOMER): 173341 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/fcff0326-dd9f-403c-b34c-2270a3d8863f_20250314T13:49_UTC.wav
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[AGENT][NEUTRAL] Contacting APL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII]. I'm calling from provider office regarding claim status.
[AGENT][NEUTRAL] OK, [PII], I can help with the claim status. What is that policy number, please?
[CUSTOMER][NEUTRAL] There
[CUSTOMER][NEUTRAL] Policy number is 01846260M for [PII] for Lima 8.
[AGENT][NEUTRAL] OK, thank you. And the insured's name and date of birth, please?
[CUSTOMER][NEUTRAL] So, it's a name, first name is There is [PII] and last name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth, [PII].
[AGENT][POSITIVE] Thank you. If I can have a callback number please in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] OK, thank you very much. And what is the date of service that you're looking for for trees?
[CUSTOMER][NEUTRAL] Yeah, it's a little service in [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And the charge amount is $15,382 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm just checking right now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This is a hospital bill.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's not
[AGENT][NEUTRAL] I'm sorry. Yeah, do you mind telling me how much the, the, the uh um
[AGENT][NEUTRAL] The amount was again uh I'm sorry, you said it's on [PII], is that what you said because I'm having troubles.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] OK, and I'm sorry, what was the bill amount again? I apologize.
[CUSTOMER][NEUTRAL] OK. Uh, it's a $15,382 even.
[AGENT][NEUTRAL] $80 even. OK, just make sure that I've got that.
[CUSTOMER][NEUTRAL] $82
[AGENT][NEUTRAL] Yes, I understand.
[CUSTOMER][NEUTRAL] 1532, 382, not even.
[AGENT][NEUTRAL] OK, thank you. I'm just checking now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like this was uh processed, um, so what, uh, your claim number on this?
[AGENT][NEUTRAL] Is 35.
[AGENT][NEUTRAL] 26304.
[AGENT][NEUTRAL] And it looks like we received that claim.
[AGENT][NEUTRAL] Checking here.
[AGENT][NEUTRAL] We received that claim on the [PII]. We processed it on the [PII].
[AGENT][NEUTRAL] And there was a check in the amount of $249.75. Now the uh-huh.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Just hold on.
[CUSTOMER][NEUTRAL] OK. Uh, sorry for, sorry for the interruption. So I noted everything on my notepad, so could you repeat again slowly? So it's received on uh what claim number, it's uh 352-6304. Is that correct?
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] OK. And the received on [PII]. Is it correct?
[AGENT][NEUTRAL] That's correct, and we processed it on the [PII].
[CUSTOMER][NEUTRAL] OK. [PII].
[AGENT][POSITIVE] It is correct.
[CUSTOMER][NEUTRAL] So, OK, what was the exact claim status claim is paid, right?
[AGENT][NEUTRAL] The, the claim has been paid, that is correct.
[CUSTOMER][NEUTRAL] OK, claim has been
[CUSTOMER][NEUTRAL] On which date?
[AGENT][NEUTRAL] It, it, it has been paid and um.
[AGENT][NEUTRAL] That's uh the check number is 201.
[CUSTOMER][NEUTRAL] No, no. I'm asking about uh on a paid on which date?
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] If the.
[CUSTOMER][NEUTRAL] No, uh, it's [PII].
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] What is the, uh, paid amount?
[AGENT][NEUTRAL] It's $249.75.
[CUSTOMER][NEUTRAL] 200
[CUSTOMER][NEUTRAL] And so actually the bill amount is $15,382 but uh paid only $249.75. So, could you, can you explain it?
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] Yes, I can. Um, so the policy pays $500 per calendar day.
[AGENT][NEUTRAL] And some other bills had already come in for the same day for this the same event. And so the remaining balance of that $500 per calendar day.
[AGENT][NEUTRAL] Was that was $249.75. Now, of course, the, the um per calendar day benefit is just a verification, not a guarantee of payment, but it it only would have paid $500 at the most, OK? But there were other bills that came in before yours, and that left a remaining balance of 24975.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now that check was cashed.
[AGENT][NEUTRAL] On the [PII], but that is the most that this policy will pay. So if there's anything else that, that is the extent of our contractual obligation. So if there's any additional payments that are due, that will be between the provider and the insured.
[AGENT][NEGATIVE] So this is the most that the policy will pay, and it's, it's already been paid out, so it's not paying any more than this.
[CUSTOMER][NEUTRAL] OK. So I claim was paid at $249.75.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. Is there any patient responsibility? OK, is there any patients responsibility?
[AGENT][NEUTRAL] Well, I can't tell you that the patient's responsible. I can just tell you that that's the most that we will pay. You'll, you'll probably want to get in touch with the, with the insured, but that's the most that we will pay.
[CUSTOMER][NEUTRAL] OK, uh, payment was done to check our EFT which one of those two a credit card.
[AGENT][NEUTRAL] Uh, I beg your pardon?
[CUSTOMER][NEUTRAL] Yeah, uh, payment was done through check or EFT credit card. Which one of those two?
[AGENT][NEUTRAL] Yeah, I'm, I'm not really understanding what you're asking. Uh, the, the check was issued to, uh, it, it was.
[CUSTOMER][NEUTRAL] OK. Is uh payment done through check, right?
[AGENT][NEUTRAL] It was, yes, I see, yes, it was done through a check. That's correct. It was a single paper check. And would you like me to give you the check number again?
[CUSTOMER][NEUTRAL] Yeah, please. Go ahead.
[AGENT][NEUTRAL] OK, the check, the check number again is 201.
[AGENT][NEUTRAL] 2005.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 2012005.
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] OK. It's a single check or by check?
[AGENT][NEUTRAL] It it was a single paper check.
[CUSTOMER][NEUTRAL] A single paper check.
[CUSTOMER][NEUTRAL] OK. And may I have the, um, may I have to check mailing address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Just hold on.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 1
[AGENT][NEUTRAL] 8
[AGENT][NEUTRAL] 6
[AGENT][NEUTRAL] 0
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right mailing address?
[AGENT][NEUTRAL] That is the mailing address. That is where it was sent.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Uh, is that cash?
[AGENT][NEUTRAL] Yes, is that
[CUSTOMER][NEUTRAL] Cash or not?
[AGENT][NEUTRAL] Yes, as I mentioned before, it was, it was cashed on [PII].
[AGENT][NEUTRAL] The [PII]
[AGENT][NEUTRAL] 20
[AGENT][NEUTRAL] 24.
[CUSTOMER][NEUTRAL] 24.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Could you, uh, uh, all the UB is also there.
[AGENT][NEUTRAL] Can, can I do what?
[CUSTOMER][NEUTRAL] OK. OK. What's your name?
[AGENT][NEUTRAL] My name is [PII]. The first letter.
[CUSTOMER][NEUTRAL] Can you spell it?
[AGENT][NEUTRAL] Yes, it's [PII]
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, and what is the call, OK, uh, what's the payer ID?
[AGENT][NEUTRAL] The payer ID is 60.
[AGENT][NEUTRAL] 801.
[CUSTOMER][NEUTRAL] OK. What was the call reference number, [PII]?
[AGENT][NEUTRAL] My name and today's date, and today's date is is uh [PII].
[CUSTOMER][NEUTRAL] OK. It's uh 0314 2025. Is it correct?
[AGENT][NEUTRAL] Is
[AGENT][POSITIVE] That is correct. Is there anything else I can help with?
[CUSTOMER][NEUTRAL] Yeah, it's clear.
[AGENT][POSITIVE] OK. Well, thank you very much for contacting APO. You have a good day.
[CUSTOMER][POSITIVE] Thank you. OK, [PII].