AccountId: 011433970860
ContactId: 0a4feeff-c673-4113-9883-8e2a562369e6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 524539 ms
Total Talk Time (AGENT): 242219 ms
Total Talk Time (CUSTOMER): 147912 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/0a4feeff-c673-4113-9883-8e2a562369e6_20250311T15:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh hi, [PII]. My name is [PII] Last initial [PII] I'm trying to see why a claim denied for Mr. [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK [PII], you're wanting claim status, is that correct? The reason for denial? OK, yes ma'am, I can help you with that. And [PII], what is a good call back number for you?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And then what is the member's policy number, please?
[CUSTOMER][NEUTRAL] Um, let me go back over here to that number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is 02550448.
[AGENT][POSITIVE] OK, [PII], thank you. Give me a couple of moments please to get the member's information all pulled up.
[CUSTOMER][NEUTRAL] OK. Yes, ma'am.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And toil, any information that I do provide would be a verification of benefits and not a guarantee of payment. If you could please give me your patient's name again and their date of birth.
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount for him?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Ma'am.
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] Oh, OK, hold on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I was doing two things at once. I apologize.
[AGENT][NEUTRAL] You're fine. No ma'am, you're fine.
[CUSTOMER][NEUTRAL] It's um $3390.87.
[AGENT][NEUTRAL] $3390.87 is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and do you already have the claim number for this data service to [PII]?
[CUSTOMER][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] OK. So it was received on [PII] and processed on [PII].
[AGENT][NEUTRAL] The claim number is 352.
[AGENT][NEUTRAL] 9252.
[AGENT][NEUTRAL] There was a benefit paid in the amount of $75.
[AGENT][NEUTRAL] That was paid on check number 2,014,800.
[AGENT][POSITIVE] That check did clear.
[CUSTOMER][NEUTRAL] Oh yeah, I see where I see where a payment was made. I see where a payment was made, but.
[AGENT][NEUTRAL] Uh-huh. And the remark on here?
[AGENT][NEUTRAL] Mhm. And this, right, the remark on the claim states with this check, the maximum benefit payable for this state of service has been met.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] This is, was not a major medical plan that he had. This was a hospital indemnity limited benefits plan.
[CUSTOMER][NEUTRAL] OK, hold on, hospital.
[AGENT][NEUTRAL] Indemnity
[CUSTOMER][NEUTRAL] Spell that please.
[AGENT][NEUTRAL] I N D E M N I T Y.
[AGENT][NEGATIVE] Limited benefit.
[CUSTOMER][NEUTRAL] A hospital indemnity plan.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Limited
[AGENT][NEUTRAL] Benefits.
[CUSTOMER][NEUTRAL] Benefits.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, so that means that $3,315.87 that you all denied is patient responsibility.
[AGENT][NEUTRAL] We do not determine patient responsibility to Neil, that would be up to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, all right.
[AGENT][NEUTRAL] Now, if you need a copy of this explanation of benefits, you should be able to print it from our portal by going to [PII].
[CUSTOMER][NEUTRAL] Hold on, I think I already, I think I got it right here. I'm trying to make sure before I.
[AGENT][NEUTRAL] OK, sure. And I believe I spoke to you because your name is different. I actually think I talked to you yesterday.
[CUSTOMER][NEUTRAL] Total benefits paid outpatient.
[CUSTOMER][NEUTRAL] Yes ma'am. OK, so on the estimation of the benefits, is it gonna show that $75 payment or no? Because this one that I got right here is, well, it's not showing that $75 payment. It's actually showing $0.
[AGENT][NEUTRAL] It would.
[AGENT][NEUTRAL] Let me look at something.
[CUSTOMER][NEGATIVE] 0 paid
[AGENT][NEUTRAL] I'm gonna pull it up and look at it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, that's
[AGENT][NEUTRAL] OK, let me look at this because it looks like it had generated two different explanation of benefits for this particular claim.
[AGENT][NEUTRAL] So let me look at this one right here to make sure that the remark is on there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] So this one does show the benefit paid and it also shows the remark that I just read to you. So give me.
[CUSTOMER][NEUTRAL] That the hospital indemnity plan limited benefits.
[AGENT][NEUTRAL] Well, that
[AGENT][NEUTRAL] That's the type of plan. It just states on the remark, it shows the 75, can you hear me?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Uh, you're breaking up. Are you still there?
[AGENT][NEUTRAL] To
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Can you hear me?
[CUSTOMER][NEUTRAL] Now I can. It's like the phone was going anymore.
[AGENT][NEUTRAL] Yeah, I don't know.
[AGENT][NEUTRAL] I don't know. I'm sorry. I don't know what's causing that. So, I do have an explanation of benefits that shows the $75 benefit paid to the provider with that remark that I just read to you about it being the maximum benefit payable for this data service. So I can send that. I'll just
[CUSTOMER][POSITIVE] It's OK. It's all right.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can you uh fax that to me?
[AGENT][NEUTRAL] Fax it to you. Mhm. Yeah. Give me just one second, please.
[AGENT][NEUTRAL] And does it need to be put to your attention, [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am, that's fine.
[CUSTOMER][NEUTRAL] And what, what's your name? I, I didn't get it. I'm sorry.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Alright, OK, yeah, I do [PII]ieve we did talk yesterday, [PII].
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] We did, cause I remember, yeah, your name was different, so.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK. And what is a good fax number for you please, [PII]?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, I'm just gonna repeat that back. [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, well I have just sent that to you so provided that there's not any type of technical mishap you should um receive that and it will also have the check number on there as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] OK, yes ma'am, thank you, Ms. [PII].
[AGENT][NEUTRAL] OK. Well, you're welcome. And can I help you with anything else, [PII]?
[CUSTOMER][NEUTRAL] Just a reference number.
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][POSITIVE] OK. All right, thank you so much.
[AGENT][POSITIVE] Well, you're welcome and thank you again for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Yes ma'am thank you I hope you do too.
[AGENT][POSITIVE] Thank you so much.
[CUSTOMER][POSITIVE] You're welcome bye bye.
[AGENT][NEUTRAL] Bye bye.