AccountId: 011433970860
ContactId: 075562f2-23f7-4bb0-af12-0014f75868e0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 306429 ms
Total Talk Time (AGENT): 127673 ms
Total Talk Time (CUSTOMER): 135406 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/075562f2-23f7-4bb0-af12-0014f75868e0_20250225T18:55_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is also [PII], and I'm calling from the offices of Paula Dalton Lex and Counseling and Psychiatry regarding an um check and an EOB we received from you all, and I just had a question about it.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the check and the explanation of benefits. And [PII], may I have a good contact number in case we're disconnected and then the policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It'll be [PII].
[CUSTOMER][NEUTRAL] And that number is going to be, the policy number is 02571338.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And do you have the claim number or the date of service if I could pick the right one? OK.
[CUSTOMER][NEUTRAL] Yes, um, the data or I have the claim number whichever one.
[AGENT][NEUTRAL] Oh, claim is better.
[CUSTOMER][NEUTRAL] OK, 356-433-3.
[AGENT][NEUTRAL] OK, this one.
[AGENT][NEUTRAL] OK, and then what questions did you have?
[CUSTOMER][NEUTRAL] Um, I have a question, so.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Well, it looks like you all paid $50. It looks like correct?
[AGENT][NEUTRAL] Mhm, yes ma'am.
[CUSTOMER][NEUTRAL] Is the rest like gonna be adjusted off or like is that like how much does the client have to pay or anything like that?
[AGENT][NEUTRAL] So we don't determine patient responsibility because we're not the major medical insurance company or a major medical insurance company. Um, so this is a hospital indemnity policy, so it just, it's a limited policy, so it'll have a certain amount for whatever the service is. So whatever that outstanding balance, it looks like it was charged $225 and we paid 50.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So that 175 um it would be whatever your your procedures are for remaining balances right off, bill the patient, we just can't determine that.
[CUSTOMER][NEUTRAL] Sure, OK, so the rest is gonna be um the client owes then.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] That would be me determining the patient responsibility, but just in general, if it's an outstanding balance, typically it's billed to the patient, but we just can't pay you to do that.
[CUSTOMER][NEUTRAL] Sure, OK, so you all are just paying 50 flat. The rest is gonna be kind of up to us on how we distribute the rest of that money.
[AGENT][POSITIVE] Correct, yes ma'am.
[CUSTOMER][NEUTRAL] Gotcha. OK, and you are his insurance company though, right? Like,
[AGENT][POSITIVE] Yes, he has his um hospital indemnity policy with us, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got you. Alright, like can I make a note just so I could make a note if anyone else has questions, um, what was you said your name is [PII] and then initial of your last name [PII]?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Alright and then um you are just saying um.
[CUSTOMER][NEUTRAL] So insurance is only paying 50, um, the remaining balance is a balance basically and it's up and it's up.
[CUSTOMER][NEUTRAL] To us how we want to go about collecting that.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And then can I ask why you all paid 50? Is that just like how much um.
[CUSTOMER][NEUTRAL] Like how do you all determine that? just so I can make a note for that as well.
[AGENT][NEUTRAL] Oh, sure. Um, so for there, it's just a benefit on their policy. Um, they have like urgent care, physician, office, physical therapy. All three of those would pay at $50 per visit with a max of $4 per calendar year. So the $50 that was one of the 50 that was used.
[CUSTOMER][NEUTRAL] OK, so he, he only has a max.
[CUSTOMER][NEUTRAL] Of for um.
[CUSTOMER][NEUTRAL] For doctors appointments that pay 50.
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][NEUTRAL] And do you know how many he has left?
[AGENT][NEUTRAL] Let's see, hold on one second.
[AGENT][NEUTRAL] He has 50/50 and 2 more.
[CUSTOMER][NEUTRAL] Alright, and then after that he uses those for um it'll be completely out of pocket for him wherever he goes.
[AGENT][NEUTRAL] Uh, for the most part, yes, if claims are received to us, they would most likely be denied because the max is met.
[CUSTOMER][NEUTRAL] Got you got you alright and then what's the call reference number?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name and today's date. Oh, I already gave you the first initial.
[AGENT][NEUTRAL] I thought I forgot I give you it.
[CUSTOMER][NEUTRAL] Yes, you said [PII]
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] All righty. Thank you, [PII].
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that'll be all thank you.
[AGENT][POSITIVE] Alright, thanks for calling [PII]. Bye-bye.
[CUSTOMER][NEUTRAL] OK bye bye.