AccountId: 011433970860
ContactId: 24eebd3b-168f-4b1a-b552-cf4dddfd9cf6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 442070 ms
Total Talk Time (AGENT): 161175 ms
Total Talk Time (CUSTOMER): 123723 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/24eebd3b-168f-4b1a-b552-cf4dddfd9cf6_20250513T15:57_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, yes, and I'm, I'm calling, uh, for my name is [PII]. I'm calling on behalf of Emmy Decatur DeKalb Medical Center on a claim.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with your claim status and [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] [PII]. The policy number for this number is 02587781.
[AGENT][NEUTRAL] That was 205-877-81?
[CUSTOMER][NEUTRAL] 02587781
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh first name is [PII] is the last name.
[CUSTOMER][NEUTRAL] Uh, let's see here, um, [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] Day of service, uh, let's see here, [PII]. It is for $32,395.29.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] 32.
[AGENT][NEUTRAL] Here we go.
[AGENT][NEUTRAL] Hold on one moment, I'm just waiting for the claim to populate here.
[AGENT][NEUTRAL] So shall we receive the claim on [PII]?
[CUSTOMER][NEUTRAL] Right, it said it was a payment made. Uh, we were expecting $16,197.65. We wanted if the claim can go back to the process for under payment.
[AGENT][NEUTRAL] Hold on one moment, let me pull up the benefits.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] What benefits used.
[AGENT][NEUTRAL] Do you mind if I place you on just a brief hold while I look at this claim?
[CUSTOMER][NEUTRAL] OK, just uh please come back.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] I mean, I will. Hold on one moment. Thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Alright, so for the hospital admission benefit.
[AGENT][NEUTRAL] $1000.01 day per CY.
[AGENT][NEUTRAL] And we paid that.
[AGENT][NEUTRAL] A daily hospital benefit.
[AGENT][NEUTRAL] $100 per day.
[AGENT][NEUTRAL] 30 max.
[AGENT][NEUTRAL] 4 days.
[AGENT][NEUTRAL] Oh ho
[AGENT][NEGATIVE] The ER wasn't paid because we already did the hos we already did. Wait.
[AGENT][POSITIVE] That's another benefit, right?
[AGENT][NEUTRAL] So.
[AGENT][NEUTRAL] And yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I need another line.
[AGENT][NEUTRAL] Come on.
[AGENT][NEUTRAL] Lion and then what's the other one while that's coming up.
[AGENT][NEUTRAL] DTV
[AGENT][NEUTRAL] Hello
[AGENT][NEUTRAL] Diagnostic test that was paid 400?
[AGENT][NEUTRAL] Right, uh-huh.
[AGENT][NEUTRAL] 400
[AGENT][NEUTRAL] Oh [PII].
[AGENT][NEUTRAL] I just wanna check on this.
[AGENT][NEUTRAL] RE MRI.
[AGENT][NEUTRAL] DE 056.
[AGENT][NEUTRAL] Those are two different benefits though.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] Should we not have paid for.
[AGENT][NEUTRAL] The ER out of this?
[AGENT][NEUTRAL] 258-5081.
[AGENT][NEUTRAL] CLHVP.
[AGENT][NEUTRAL] They only use one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, thank you so much for holding. I apologize for that wait. So, although the 16,000 was expected, the policy, this is a hospital indemnity policy, so it's a limited medical benefit policy. So the
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh yeah, I run into these before, yeah, OK, hospital indemnity plan, so it's only limited to a certain amount of money. OK, OK.
[AGENT][NEUTRAL] Yeah, so
[AGENT][NEUTRAL] Well, not a certain amount of money. It's there's benefits and the, go ahead.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Well, you only pay
[CUSTOMER][NEGATIVE] Right, but $181,800 was paid, so you, you're not gonna pay any more than that.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Is that right? So that's what, that's, that's what I meant, uh, putting in a simple terms there. So, OK, hospital identity plan.
[CUSTOMER][NEUTRAL] Uh, so the, the, sort of, so then the rest of the response is pretty much is that, would that be patient responsibility then?
[AGENT][NEUTRAL] Uh, we don't determine patient responsibility because we're not the major medical, it'll be whatever your policies are on the outstanding and remaining balances.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] So, so it's up, so it's up to the provider in this case, OK, alright, alright, well thank you very much for that [PII]. I appreciate that. I just wanted to.
[CUSTOMER][NEUTRAL] Uh, let me see what else here you have the claim number?
[AGENT][NEUTRAL] Yes, it's 359.
[CUSTOMER][NEUTRAL] But the bill number?
[AGENT][NEUTRAL] 656 1.
[CUSTOMER][NEUTRAL] OK, alright, and do you have a reference number for this call?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name and today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] All right, thank you very much. Have a great day.
[AGENT][POSITIVE] You also, thanks for calling APO. Bye bye.
[CUSTOMER][POSITIVE] Thank you bye now.