AccountId: 011433970860
ContactId: 05df025d-1baa-4be8-add2-c9096d95bbb5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 196059 ms
Total Talk Time (AGENT): 83929 ms
Total Talk Time (CUSTOMER): 69101 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/05df025d-1baa-4be8-add2-c9096d95bbb5_20250429T21:00_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I'm calling from a provider's office and I'm just trying to get clarification on uh processing of a claim, please for a patient.
[AGENT][NEUTRAL] All right. Happy to check a claim. What's the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, it is 02576525.
[AGENT][NEUTRAL] Right
[AGENT][NEUTRAL] And then [PII] if I get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, [PII], [PII].
[AGENT][NEUTRAL] Alright thank you and then what's the date of service?
[CUSTOMER][NEUTRAL] [PII], uh, the total charge is $126.
[AGENT][NEUTRAL] OK, let's see
[CUSTOMER][NEUTRAL] I have the remit in front of me, but.
[CUSTOMER][NEUTRAL] I just, I just need clarification.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it looks like uh there was a check sent benefit amount of $50. It looks this was the maximum benefit payable for the state of service.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So is the remaining is that patient responsibility is that a provider adjustment? It doesn't really say on the agreement.
[AGENT][NEUTRAL] Yeah, we don't really, we don't advise on patient responsibility that's up to the provider facility. Um, the patient's plan is a limited benefit plan, so that's why it's just paying the set amount, um, it, you know, it'll pay whatever that amount is depending upon what they're being seen for it's not gonna pay a percentage or more.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] It's up to the provider then to.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][MIXED] That's very interesting. I guess this isn't really.
[CUSTOMER][NEUTRAL] OK, I will check on that then, um, I've never heard of that.
[AGENT][NEUTRAL] Yeah, it's a hospital, it's a hospital indemnity plan, so it's not a major medical plan.
[CUSTOMER][NEUTRAL] So it's just basically.
[CUSTOMER][NEUTRAL] OK, not a major medical plan.
[AGENT][NEGATIVE] Yeah, that's why it just pays that set amount and there's nothing above or beyond.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, may I have a reference number please?
[AGENT][NEUTRAL] Absolutely. Call reference would be my name with the initial to my last name and then today's date. My name again is [PII], that's spelled [PII] Last initial to my name is [PII], and then today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, well, thank you for your help. I appreciate it.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][NEUTRAL] Bye-bye.