AccountId: 011433970860
ContactId: 100c9f15-6ed6-437b-9c26-a1490bd8d214
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 343350 ms
Total Talk Time (AGENT): 155556 ms
Total Talk Time (CUSTOMER): 88011 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/100c9f15-6ed6-437b-9c26-a1490bd8d214_20250314T15:02_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Good morning. My name is [PII]. I'm calling from Prisma Health, and I, I wanted to check claim status.
[AGENT][NEUTRAL] OK, sure, I can assist you with claims, Ms. [PII]. Um, OK, and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number please?
[CUSTOMER][NEUTRAL] Uh yes, it is D as in David 43730287.
[AGENT][NEUTRAL] Do you see a policy certificate number? It's gonna start with a 0 followed by 7 digits.
[CUSTOMER][NEUTRAL] Yes, 02481710.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Sure, [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. May I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] Total bill amount was $122,732.64.
[AGENT][POSITIVE] OK, thank you. Let me see if I can find this plan for you.
[AGENT][NEUTRAL] And for future
[CUSTOMER][NEUTRAL] I'm sorry, what was your name?
[AGENT][NEUTRAL] Um, my name is [PII]. That's [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Let me pull the ALP on this one, OK, one moment.
[AGENT][NEUTRAL] I'm still waiting on the EOB's gonna be a minute.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so it looks like we have um processed this claim on [PII].
[AGENT][NEUTRAL] And we send a benefit amount of 3300 to the provider.
[CUSTOMER][NEUTRAL] Yeah, we did get that.
[AGENT][NEUTRAL] OK, how may I assist you?
[CUSTOMER][NEUTRAL] Um, I guess, like, is this a limited benefit plan, uh.
[AGENT][NEUTRAL] Mhm, it is.
[CUSTOMER][NEUTRAL] OK, policy.
[CUSTOMER][NEUTRAL] Can you provide the plan like details like what the maximum is and all that?
[AGENT][NEUTRAL] Sure. Mhm. Yes, and this is not a guarantee of payment, just a verification of coverage. And let's see. OK, let me go ahead and write this down a little bit.
[AGENT][NEUTRAL] OK, so this one has a daily hospital confinement benefit of $100 daily.
[CUSTOMER][NEUTRAL] $100? OK.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Mhm. $100 daily. Um, the first annual occurrence is $1500.
[CUSTOMER][NEUTRAL] First annual occurrence is how much? I'm sorry.
[AGENT][NEUTRAL] 1500.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the intensive care benefit is $400 daily.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that it looks like that's all the benefits that is in the policy. There is an office visit benefit which it looks like it's, it's not for this one because this was a hospitalization. And then there's a wellness and diagnostic testing. The wellness and diagnostic testing is uh 250 per year. And then there's surgery benefits up to 2000 for surgery.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Which this one didn't have that. OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the remaining balance is patient responsibility?
[AGENT][NEUTRAL] It's up to the provider's discretion. We don't have any con uh contractual involvement on the remaining. We don't know if they have any, any other policies out there like any other major medicals or any other policies, because this is just a limited policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, can I have a reference number for our call, please?
[AGENT][NEUTRAL] We don't have reference numbers. Now you can use my name in today's date if you will. You need the spelling of my name or any other information?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh, no, I got it. Thank you so much for your help. I appreciate it.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] You're welcome and thank you for calling APPO. Have a good day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.