AccountId: 011433970860
ContactId: 01410b1a-2400-4ea6-9fc0-b6e0aa2a9106
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 252490 ms
Total Talk Time (AGENT): 102159 ms
Total Talk Time (CUSTOMER): 98095 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/01410b1a-2400-4ea6-9fc0-b6e0aa2a9106_20250407T15:29_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] How may I help you?
[CUSTOMER][NEUTRAL] Uh, yes, good morning, Miss [PII]. My name is [PII] and I'm calling uh from the provider's office trying to check on a claim please.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the claim status, and [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Uh, sure, [PII] is the phone number and patient ID is gonna be [PII].
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] way
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh yes, the patient's gonna be [PII], and that's with a [PII] Uh date of birth [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim you want me to check on?
[CUSTOMER][NEUTRAL] Uh, yes, it's from [PII] and that total charge, uh, $747. I do believe, let me just make sure.
[CUSTOMER][NEUTRAL] Uh yeah, that was the total charge and that rendering provider is the doctor's office is Doctor [PII] Nice [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, hold on one moment. 58.
[CUSTOMER][POSITIVE] You're good take your time.
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 351-6358.
[AGENT][NEUTRAL] And on [PII], the claim was denied because the benefit maximum for the data service has been met.
[CUSTOMER][NEUTRAL] And maximum.
[AGENT][NEUTRAL] Let me see how this was paid.
[AGENT][NEUTRAL] Oh, OK. Let me see what the max is. Hold on one moment.
[AGENT][NEUTRAL] So for the um.
[AGENT][NEUTRAL] Accidental and sickness, um, surgical benefit, the policy will pay up to $1000.02 times per calendar year. And that was, there was a claim that came in for the same date of service that $1000 was applied to before the other claims came in.
[CUSTOMER][NEUTRAL] OK, so this is like a just a specific uh benefit maximum plan that they're you're only gonna pay $1000 per surgical event I guess or whatever is that correct?
[AGENT][NEUTRAL] Right, it's a hospital indemnity policy, so it's a limited medical um benefit policy, um, but yes, for the surgery, it pays twice a year at 1000.
[CUSTOMER][NEUTRAL] OK, and whichever client comes in first is just basically the one that gets paid, I guess.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Alrighty, now was there any contractual adjustments on that particular one or any provider discount for that or is the place you're responsible for that whole 747?
[AGENT][NEUTRAL] Um, so we don't determine patient responsibility because we're not a major medical, but there are no other discounts, um, applied from APL.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh OK, alrighty.
[CUSTOMER][POSITIVE] Alrighty and I have your name as [PII] and if I can get a good call reference number I think that should do it.
[AGENT][NEUTRAL] Alrighty, well, there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty thank you so much and you have a great rest of your day.
[AGENT][POSITIVE] Thank you, you also, and thanks for calling APL [PII]. Bye-bye.
[CUSTOMER][POSITIVE] Thanks bye bye.