AccountId: 011433970860
ContactId: 22db300d-9285-4695-82f2-0db03544d636
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 241100 ms
Total Talk Time (AGENT): 112972 ms
Total Talk Time (CUSTOMER): 61473 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/22db300d-9285-4695-82f2-0db03544d636_20250303T15:16_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, yes, I am calling about a claim for a patient.
[AGENT][NEUTRAL] OK, you're needing to check claim status for a member, is that correct?
[CUSTOMER][NEUTRAL] Well, I'm trying to find out some information about what part of the claim divide.
[AGENT][NEUTRAL] OK, you're needing clarification on it, is that correct? Yes, ma'am, I can help you with that. OK. And who am I speaking with?
[CUSTOMER][POSITIVE] Yes ma'am, yes ma'am, that's that's correct.
[CUSTOMER][NEUTRAL] My name is [PII]. My last initial [PII].
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] I'm sorry, you said [PII] is your first name? OK, thank you and [PII], what is your callback number?
[CUSTOMER][POSITIVE] Yeah, yes ma'am.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the member's policy number, please, [PII].
[CUSTOMER][NEUTRAL] It's 02469142.
[AGENT][NEUTRAL] OK, thank you one moment while I get the member's information pulled up.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name, please, and their date of birth?
[CUSTOMER][NEUTRAL] [PII], her date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her place?
[CUSTOMER][NEUTRAL] Data service is [PII] and the total charge amount is $269.60.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And do you already have the claim number?
[CUSTOMER][NEUTRAL] Um, I think, I think so, yes, ma'am. Hold on.
[CUSTOMER][NEUTRAL] Yes ma'am, uh, well, let's see, yes, I have, I have the claim number.
[AGENT][NEUTRAL] It's 355-6400.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][POSITIVE] Yes ma'am, that's correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so let's see.
[AGENT][NEUTRAL] OK, so I do show there was a $75 benefit paid and the code that was denied.
[AGENT][NEUTRAL] It states the maximum benefit payable for this data service has been met. This is not a major medical insurance plan, [PII]. It's a hospital indemnity limited benefit plan.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So with that $75 that was paid, that was the maximum benefit payable for that data service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's what we thought but I just wanted to clarify to make sure that that's exactly what it was.
[AGENT][NEUTRAL] Yes ma'am and then [PII], I don't know if you're already aware of this, but we do have a portal so in the future if you need a copy of an explanation of benefits, you should be able to get that by going to our our portal which is located at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, thank you. Can I get a reference number?
[AGENT][NEUTRAL] OK. Sure, you would use my name along with today's date.
[CUSTOMER][POSITIVE] OK great thank you I do appreciate your help.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, you are certainly very welcome so if that's all that I can help you with, thank you again for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][POSITIVE] Uh-huh, you're welcome. Bye bye.