AccountId: 011433970860
ContactId: 09d9ef53-c5ec-4344-940d-70b50d114860
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 733780 ms
Total Talk Time (AGENT): 173323 ms
Total Talk Time (CUSTOMER): 226293 ms
Interruptions: 3
Overall Sentiment: AGENT=0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/09d9ef53-c5ec-4344-940d-70b50d114860_20250314T18:18_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Hello, [PII]. My name is [PII]. I'm calling from provider office regarding claim status.
[AGENT][NEUTRAL] OK, I can check on a claim for you. You said your name was [PII]?
[CUSTOMER][NEUTRAL] Uh, it's A for Alpha, V for Victor, I for India, and initial is B, B for boy.
[AGENT][POSITIVE] Got it thank you. And then I, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] So, it's [PII].
[AGENT][NEUTRAL] Thank you. And then did you have the policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Policy number 018.
[CUSTOMER][NEUTRAL] 46
[CUSTOMER][NEUTRAL] 26
[CUSTOMER][NEUTRAL] 0 M for Mike, L for Lisa.
[CUSTOMER][NEUTRAL] And 8
[AGENT][NEUTRAL] OK and uh what was the name and date of birth for the patient, please?
[CUSTOMER][NEUTRAL] Yeah, patient's name is [PII]. and the date of birth is [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that. I'll be. Do you, um, what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Yeah, it's uh [PII].
[AGENT][NEUTRAL] OK, and that building out please.
[CUSTOMER][NEUTRAL] Uh, it's bill amount um.
[CUSTOMER][NEUTRAL] $15,382 even.
[AGENT][NEUTRAL] That was 15,382.
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK thank you one moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Was that the amount before or after major medical pay to Avi?
[CUSTOMER][NEUTRAL] Can you repeat again?
[AGENT][NEUTRAL] Was that amount the uh excuse me, the amount that you gave me was that uh before or after major medical paid?
[CUSTOMER][NEUTRAL] The, actually, uh,
[CUSTOMER][NEUTRAL] Previously, I
[CUSTOMER][NEUTRAL] Uh, to, uh, talk with representative named, uh, [PII].
[CUSTOMER][NEUTRAL] As uh I get the total information for this number, but um, uh, unfortunately, suddenly call was disconnected. So actually, I need that information only on um.
[CUSTOMER][NEUTRAL] To, um
[CUSTOMER][NEUTRAL] Are you visible if, uh, yeah?
[CUSTOMER][NEUTRAL] OK. Uh, the bill amount is $15,380 even is the current.
[AGENT][NEUTRAL] OK, OK. So that's, that's before major medical pay.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what was the name of the provider's office that you were with? I'm sorry.
[CUSTOMER][NEUTRAL] So, this is the primary pet?
[CUSTOMER][NEUTRAL] Yeah, it's a Holy Cross Hospital.
[AGENT][NEUTRAL] It's Holy Cross, OK.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] All right, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I did find this claim on I apologize for the wait. Um, so for this claim we paid a benefit of $249.75. You'll give me one moment, I'll get all of that information to you. Oh, go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] Yes, yes, so,
[CUSTOMER][NEUTRAL] Yeah, actually, uh, the bill amount is $15,382 and the uh primary did not pay anything. So it's adjusted for 1 $14,466 even.
[CUSTOMER][NEUTRAL] And the crossover to, uh, crossover one secondary to $916 to American Public Life. It's correct. So, yeah.
[AGENT][POSITIVE] Right, yes, correct, that is the amount that we received, yes.
[CUSTOMER][NEUTRAL] Yes, uh, and, uh, paid only $249.75 only. So the remaining balance is $6666.25. What was that, uh, can you explain the remaining balance? What was the reason for that?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Uh, this payment that we made met their maximum for this date of service.
[CUSTOMER][NEUTRAL] OK. Uh, maximum benefits existed, right?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Yes, maximum benefits has been exacted on, so that's the, uh, that's the reason.
[AGENT][NEUTRAL] Correct, their the outpatient, yes, their outpatient benefit is on a per calendar day basis and so it had already been met.
[CUSTOMER][NEUTRAL] OK. Uh, OK, I can understand. Uh, please let, uh, I want to check it once, uh, please let me hold on 2 minutes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, thank you for being on hold.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] So you said that the maximum benefit adjuster. So it's a primary and the secondary, the exhaust.
[AGENT][NEGATIVE] That the payment that we made did meet their maximum, we were unable to pay any additional benefits.
[CUSTOMER][NEUTRAL] OK, it's a $1 or value. What was that?
[AGENT][NEUTRAL] Yes, so per calendar day the outpatient benefit pays up to $500 per calendar day.
[CUSTOMER][NEUTRAL] How many calories?
[AGENT][NEUTRAL] There's no limit on uh there's not a yearly maximum or daily, um, like how many days it's simply $500 max per day.
[CUSTOMER][NEUTRAL] It's $500 maximum, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Is there any possible to, uh,
[CUSTOMER][NEUTRAL] Where you process the claim.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] OK. Uh, please let me hold on one minute.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, thank you for being on hold.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, uh, uh, patient, how many, uh, how many dollars can be met the patient per year, per year?
[CUSTOMER][NEUTRAL] Annual.
[AGENT][NEUTRAL] There's not an annual maximum, it's simply a daily limit.
[CUSTOMER][NEUTRAL] Oh it's uh simply daily limit.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And it, uh, OK, is there any other option to process the claim?
[AGENT][NEUTRAL] No, as they had met their maximum we had paid previously for other claims on the state of service that was the maximum amount payable.
[CUSTOMER][NEUTRAL] OK, the remaining balance has been paid to patients, right?
[AGENT][NEUTRAL] That but this payment that we sent to you met their maximum.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Could you uh could you please let me hold on 2 minutes?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Thank you for being on hold.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and the remaining $666.25 has been patient's responsibility.
[AGENT][NEUTRAL] We do not say what is patient responsibility that would be up to the provider.
[CUSTOMER][MIXED] OK, but it shows the balance amount.
[AGENT][NEUTRAL] Yeah, we don't say what is patient responsibility that's up to the provider.
[CUSTOMER][NEUTRAL] OK, uh,
[CUSTOMER][NEUTRAL] Yeah, it's like, uh, may I get the dinner date?
[AGENT][NEUTRAL] Yes, give me just a moment, let me get that.
[AGENT][NEUTRAL] So that was uh [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], yes.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. And uh
[CUSTOMER][NEUTRAL] OK. Uh, may I know the maximum benefit in terms of dollars is $500 right?
[AGENT][NEUTRAL] Yes, per calendar day it is $500 limit.
[CUSTOMER][NEUTRAL] OK. Uh, how much, uh, amount is allowed?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, how much amount has, OK, how much dollar amount is allowed?
[AGENT][NEUTRAL] It's $500 per calendar day.
[CUSTOMER][NEUTRAL] Or calendar day. OK, OK.
[CUSTOMER][NEUTRAL] How much, how much amount as the patient, excluding this claim?
[AGENT][NEUTRAL] That be the benefit that we paid you met that $500 maximum.
[CUSTOMER][NEUTRAL] OK. It's also $500 is the maximum.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Uh, what's your name? It's OK, right?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] Got you. Uh.
[CUSTOMER][NEUTRAL] What is the call reference number?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. uh so my last initial is [PII], was there anything else I could help you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, it's clear.
[AGENT][POSITIVE] OK, thanks for calling APL have a great rest of your day.
[CUSTOMER][NEUTRAL] OK. Bye-bye now.
[AGENT][NEUTRAL] Bye bye.