AccountId: 011433970860
ContactId: 1c12f678-a1a4-420e-839a-8053187cdaee
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 316179 ms
Total Talk Time (AGENT): 108281 ms
Total Talk Time (CUSTOMER): 131597 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/1c12f678-a1a4-420e-839a-8053187cdaee_20250214T16:56_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi this is [PII] um I just have a couple of questions on a claim we've received a payment one. I'm trying to see if there's any patient responsibility.
[AGENT][NEUTRAL] OK, I can check and see what type of policy the member has, Miss [PII]. Um, may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. And may I have the name of the facility or the provider you're calling from?
[CUSTOMER][NEUTRAL] UVA Health Sciences Center.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number, Miss?
[CUSTOMER][NEUTRAL] Yes it is.
[CUSTOMER][NEUTRAL] D as in David 43302088.
[AGENT][NEUTRAL] Do you see a policy certificate number? It's gonna start with a 0 followed by 7 digits. That's gonna be your number.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] A 0 followed by 7 digits.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No. Um, it looks like when I had called previous, I was told that the member ID was through I IMA which is wellness and Preventive Only, and then I was told the medical was under member ID.
[CUSTOMER][NEUTRAL] 247-491-3
[AGENT][POSITIVE] Mhm, that's it. Thank you. One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] It's [PII], [PII].
[AGENT][NEUTRAL] Do you have a claim number or you have the date of service?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I have let me see if I have the claim number.
[CUSTOMER][NEUTRAL] Yeah, it looks like the claim number is 345-0895.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 8 of April [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so this particular policy is one of our limited hospital indemnity plans. Um, with this one it pays an indemnity amount which is a flat amount. Um, this is not a major medical, so we do not apply anything towards the deductible co-payment or co-insurance or member's responsibility. We don't know if they have any other policies out there, so it's up to the provider's discretion for the remaining balance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um whether we sent this to the wrong the member ID for IMA even if we built the um I'm sorry, build this under the member ID 247-4913, it would still pay the same benefits, right, the $875 that we received.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Correct, yes, because this is just a flat amount, which is an indemnity amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Ademnity amount.
[AGENT][NEUTRAL] Yes, it's an indemnity amount which is a flat amount, set amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK, I'm just trying to get some more information um on it just you know so we can make sure um OK and I think let me just check something real quick.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And did this go through was this priced like through any networks or anything like that or it's just.
[CUSTOMER][NEUTRAL] Um, it's just this like you said, just a limited policy and that's it, it's not through any networks or anything.
[AGENT][NEUTRAL] Uh, correct, it's just a, uh, limited policy, um, basically, if the provider participates in multiple they get that additional discount but it is not required because we're not contracted.
[AGENT][NEUTRAL] So we're just gonna pay the flat amount and that's all.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, I got you alright perfect and do you happen to have a call reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will. Do you need the spelling of my name or any other information?
[CUSTOMER][POSITIVE] Yeah, if you could spell your name, that'd be great.
[AGENT][NEUTRAL] OK, that is [PII].
[CUSTOMER][POSITIVE] OK, alright, well thank you so much for your help you have a good day.
[AGENT][POSITIVE] You as well and thank you for calling APL.
[CUSTOMER][POSITIVE] Thanks bye bye.
[AGENT][NEUTRAL] Mm.