AccountId: 011433970860
ContactId: 278ee18c-b177-4762-af80-8ad31d3f62e8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 225539 ms
Total Talk Time (AGENT): 104248 ms
Total Talk Time (CUSTOMER): 67931 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/278ee18c-b177-4762-af80-8ad31d3f62e8_20250212T21:54_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] How you doing, [PII]? My name is [PII], and I'm calling in reference to a medical claim.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status. [PII], and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] and that's my direct line.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] 025837887
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [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 for the claim you want me to check on?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And it's $120,070.89.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] HCA Florida Citrus Hospital.
[AGENT][NEUTRAL] Here we go, hold on one moment.
[AGENT][NEUTRAL] Alright, so I should received the claim on [PII]. Um, that claim number is 355.
[AGENT][NEUTRAL] 5378.
[AGENT][NEUTRAL] And on [PII], the claim was placed on hold as we're waiting for eligibility from their employer.
[AGENT][NEUTRAL] As soon as we receive eligibility from the um employer, we continue processing the claim.
[CUSTOMER][NEUTRAL] OK, um, and what's the effective date of the patient's coverage as of now?
[AGENT][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and what network is used for the um pricing of facility claims?
[AGENT][NEUTRAL] Um, this is, let me see.
[AGENT][NEUTRAL] Yeah, this isn't on a network. It's just a hospital indemnity policy. It's a limited medical benefit plan.
[CUSTOMER][NEUTRAL] OK, and for ER services is, is covered, is it covered?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So there is a um daily hospital confinement benefit and then um the first occurrence when there is a hospital admission um or confinement will pay up to $1500 and then $30 per day for confinement.
[CUSTOMER][NEUTRAL] Right, this is ER.
[CUSTOMER][NEUTRAL] Right, this is an ER claim though.
[CUSTOMER][NEUTRAL] Is ER coverage is is there ER coverage?
[AGENT][NEUTRAL] OK, so in terms of ER room, no, that's outpatient. There's no outpatient coverage on here.
[CUSTOMER][NEUTRAL] OK, no outpatient coverage.
[CUSTOMER][NEUTRAL] Alrighty and then um the, and how long do you allow for the employees to respond to you all?
[AGENT][NEUTRAL] Um, there's no turnaround time. Just once we receive it, we go ahead and process because there's no timely filing for our claims.
[CUSTOMER][NEUTRAL] Alright, and the reference number for the call?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Alright and thank you for all your help and I hope you have a good one.
[AGENT][POSITIVE] Thank you, you also, and thanks for calling APL. Bye bye.
[CUSTOMER][POSITIVE] Thank you bye bye.