AccountId: 011433970860
ContactId: 233dd156-572a-4e9c-8f6a-07d1ecc13701
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 362250 ms
Total Talk Time (AGENT): 86457 ms
Total Talk Time (CUSTOMER): 102911 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/233dd156-572a-4e9c-8f6a-07d1ecc13701_20250404T15:16_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII].
[CUSTOMER][NEUTRAL] And I was, uh, I'm reviewing a claim here and I just wanted to see if you had the correct charges on this claim.
[AGENT][NEUTRAL] OK, is it for yourself?
[CUSTOMER][NEUTRAL] No, it's for a patient. I'm calling from provider's office.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] OK, [PII], can I get a good callback number?
[CUSTOMER][NEUTRAL] Yes, it's [PII], 1 moment, let me get it it's [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Do you have the policy number of the patient?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yes, it is.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 02441374
[AGENT][NEUTRAL] OK, we were wanting to check claim status, is that right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, what's that patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And the date of service.
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] [PII]. I'm sorry, [PII].
[AGENT][NEUTRAL] And what were the bill charges?
[CUSTOMER][NEUTRAL] I have an EOB.
[AGENT][NEUTRAL] Oh, OK, what's the.
[CUSTOMER][NEUTRAL] Uh, the total charge, the claim number?
[AGENT][NEUTRAL] Yeah, please.
[CUSTOMER][NEUTRAL] Or, OK, so on the claim it shows the charge, the charges is only $350 and the claim number is 3557026, but we actually billed more than that so I'm not sure.
[AGENT][NEUTRAL] All right, let's see what's going on.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] All right, let me pull up what we received.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Can you hear me?
[CUSTOMER][NEUTRAL] Yes. No, I didn't hear anything at first. I'm just not hearing you.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Oh, OK, um, what were?
[CUSTOMER][NEUTRAL] So if you did say something, I didn't hear it.
[AGENT][NEUTRAL] The bill charges for the 20138.
[CUSTOMER][NEUTRAL] Uh, let's see, 2013, yes, that's the total.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Yeah let's see.
[AGENT][NEUTRAL] OK, yeah, and we paid 350. I think that's the max that's paid on the plan, but let me pull that up as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Was this an ER visit, is that right?
[CUSTOMER][NEUTRAL] It was, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so for ER it's 350, that's the maximum it'll pay out is 350 per day, a max of 2 days per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the other charges were not um considered.
[AGENT][NEUTRAL] Yeah, so this is a hospital indemnity plan. It's like a supplemental plan. It's not a major medical, it pays a certain dollar amount for certain services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got you. Alright, is that on the EOB because the one I have, it just shows just the charge charges was $350 and you just pay $350.
[AGENT][NEUTRAL] No, it's, I don't, no, it's not on the POB, yeah, it just, it will just tell what we paid on the policy, um.
[CUSTOMER][NEUTRAL] So is there
[AGENT][NEUTRAL] But, but yeah, this is a hospital indemnity supplemental plan so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and do you give reference number, [PII]?
[AGENT][NEUTRAL] Uh, just my name, [PII], first initial, last name, [PII], and today's date.
[CUSTOMER][NEUTRAL] OK, and so it paid per patient plan indemnity plan, OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Alright, got it, thank you so much for your help.
[AGENT][POSITIVE] OK, well thank you for calling APL. I hope you have a good weekend.
[CUSTOMER][NEUTRAL] You too bye bye.