AccountId: 011433970860
ContactId: 295e2999-edc8-4d9d-8d8f-78a544a597bc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 332739 ms
Total Talk Time (AGENT): 144094 ms
Total Talk Time (CUSTOMER): 127000 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/295e2999-edc8-4d9d-8d8f-78a544a597bc_20250403T15:19_UTC.wav
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[AGENT][POSITIVE] Good Morning. Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] with Caldwell Medical Center. Um, I have a claim that was processed that I was needing, I have some questions about, please.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, [PII], so you're needing some additional information on a claim we processed, is that correct?
[CUSTOMER][POSITIVE] Yes, yes please.
[AGENT][POSITIVE] Yes ma'am, I can help you with that. And [PII], what is a good call back number for you?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII] that's a direct line.
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] It is 3,576,490.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] You said 3,576,490?
[CUSTOMER][NEUTRAL] 2703650329
[AGENT][NEUTRAL] OK, so let's start that all over because apparently I didn't.
[CUSTOMER][NEGATIVE] Yes, and let me slow down because that is very rude to to speak too fast so let me slow down.
[AGENT][POSITIVE] OK. All right. I'm ready.
[CUSTOMER][NEUTRAL] 270270365.
[CUSTOMER][NEUTRAL] 0329.
[AGENT][NEUTRAL] OK, now that is not an APO policy number.
[CUSTOMER][NEUTRAL] OK, I thought she was needing my contact number. The policy number is 02.
[AGENT][NEUTRAL] No, that's your uh-huh.
[CUSTOMER][NEUTRAL] 02559856
[AGENT][NEUTRAL] OK, what was the
[CUSTOMER][NEUTRAL] I am a provider.
[AGENT][NEUTRAL] OK, yes. OK, so just one moment.
[AGENT][NEUTRAL] And let me get that information pulled up please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's still loading [PII], just a moment.
[CUSTOMER][NEUTRAL] OK, that's fine.
[AGENT][NEUTRAL] OK, and [PII], any information that I do provide for you will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] His name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the date of service and total bill amount?
[CUSTOMER][NEUTRAL] Data service is [PII] total bill amount is $2,409.30.
[AGENT][NEUTRAL] OK, thank you. And do you have the claim number that you're calling about?
[CUSTOMER][NEUTRAL] I do. It is uh 357-6490.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK. So, yes, ma'am. I do have that claim pulled up and how can I help you with that?
[CUSTOMER][NEUTRAL] Well, uh, the only balance or the check that we received was only for $75 and as you can see the bill was $2,409.30. Is the remaining balance the patient responsibility?
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] This, we do not determine patient responsibility, that would be up to the provider. Um, with that $75 payment, Jill, that was the maximum benefit payable for this state of service. This is not major medical insurance. This is a hospital indemnity limited benefit plan.
[CUSTOMER][NEUTRAL] OK, so we always go off of the insurance on what the patient is responsible for, so you're just saying this is just a policy that if the patient goes to the hospital, you pay $75 and that's it.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Correct. It has certain, it, this plan pays specific dollar amounts for certain services.
[AGENT][NEUTRAL] So for this data service, this was the maximum benefit for this event.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK, OK, uh, so it has nothing to do with us being in network or anything like that that's just what the the policy is, OK, alright, that's all I needed [PII], do you have a reference number?
[AGENT][NEUTRAL] No, ma'am.
[AGENT][POSITIVE] That is correct. Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am, and if you
[AGENT][NEUTRAL] Sure you would use my name along with today's date and then if in the future you ever need a copy of one of our explanation of benefits, you should be able to go to our portal deal to print that out and our portal website is located at secured.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you very much I appreciate your help.
[AGENT][POSITIVE] Well, you are certainly very welcome. And again, is there anything else that I can help you with?
[CUSTOMER][POSITIVE] No, I think you took care of it. You have a good Thursday.
[AGENT][NEUTRAL] Oh, well, I hope it's a Friday eve. That's what I call Thursdays, [PII] Friday eve.
[CUSTOMER][POSITIVE] Yes it is, yes, yes, yes, definitely.
[AGENT][POSITIVE] So I hope you have a great day too, and thank you again for calling APL. Yes, ma'am.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Bye bye.