AccountId: 011433970860
ContactId: 29900e42-cddd-4785-9c17-da8710e44995
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 304140 ms
Total Talk Time (AGENT): 146417 ms
Total Talk Time (CUSTOMER): 99701 ms
Interruptions: 1
Overall Sentiment: AGENT=1.8, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/29900e42-cddd-4785-9c17-da8710e44995_20250409T14:20_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] Hi, I need to um speak with you in reference to a payment that was made to our hospital.
[AGENT][POSITIVE] Well, it would be my pleasure to assist you. May I ask your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, [PII], and a good callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, [PII]. And do you have the claim number or the patient's policy number?
[CUSTOMER][NEUTRAL] I have the policy number as 02570325.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the patient's name and date of birth, please, ma'am?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] What was the date of service or claim number?
[CUSTOMER][NEUTRAL] Data services 1-18-2025.
[AGENT][NEUTRAL] 1 18 2025. Let me get that pulled up.
[AGENT][NEUTRAL] And what is the facility name?
[CUSTOMER][NEUTRAL] It's Houston spelled like Houston Healthcare.
[CUSTOMER][NEUTRAL] Your EOB has Houston Hospitals.
[AGENT][NEUTRAL] And you said 1 18 2025?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] And what was the benefit amount on that claim?
[CUSTOMER][NEUTRAL] What do you mean when you say benefit amount?
[AGENT][NEUTRAL] Are you talking about a payment that you've received?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] You want the payment that you guys made?
[AGENT][NEUTRAL] What I was asking, was it a $50 payment?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] And are you looking at the EOB?
[CUSTOMER][NEUTRAL] I do have it, but my question is, um, is this policy like a limited benefit plan and you guys just play us pay a set rate for the visit?
[AGENT][NEUTRAL] It is and the reason I kept asking for the claim number is because it looks like we have a different provider name.
[AGENT][NEUTRAL] On that claim.
[CUSTOMER][NEUTRAL] Is it the house in hospitals because that's what the EOB says.
[AGENT][NEUTRAL] No, just one minute, I was trying to make sure I was looking at the right.
[AGENT][NEUTRAL] Claim for 11825.
[CUSTOMER][NEUTRAL] OK, let me give you, OK, I'll give you the claim number.
[AGENT][POSITIVE] OK, thank you. Yeah, I'm ready.
[CUSTOMER][NEUTRAL] You ready?
[CUSTOMER][NEUTRAL] It's I have 357-803-3.
[AGENT][NEUTRAL] That's what I have.
[AGENT][NEUTRAL] And you said on the EOB it says Houston Medical Center?
[CUSTOMER][NEUTRAL] This is Houston Hospital MedStops.
[AGENT][NEUTRAL] I, I'm so sorry. I just wanna make sure, you know. What about Pavilion MedStop? Does it have that listed on it?
[CUSTOMER][NEUTRAL] Yeah, that, well, that's a facility we bill for.
[AGENT][NEUTRAL] OK, OK. That's what was confusing me.
[CUSTOMER][NEUTRAL] Yeah, and that's where she, that's where.
[CUSTOMER][NEUTRAL] Yeah, he was actually treated there.
[AGENT][NEUTRAL] OK, I was looking for [PII]. I'm like, I don't see [PII] anyway.
[CUSTOMER][NEUTRAL] Yes, that is one of ours.
[AGENT][NEUTRAL] OK. All right. Thank you. I appreciate that clarification. So yes, ma'am, this is a limited indemnity policy and so the maximum benefit for that date was $50. Now, we don't determine patient responsibility.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] If you are a multi plan provider, you should have received a repricing EOB from multi plan but it doesn't affect the processing of our claim.
[CUSTOMER][NEUTRAL] Right, but y'all don't coordinate with a primary either, do you?
[AGENT][NEUTRAL] Not with this indemnity policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK and.
[CUSTOMER][NEUTRAL] Um, if the, if the, the account is overpaid when you guys paid the $50 can we just refund the patient?
[AGENT][NEUTRAL] You can.
[AGENT][NEUTRAL] Any overpayment can go to the patient.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, do y'all give reference numbers?
[AGENT][NEUTRAL] The reference number would be my name and today's date, and I spell my name [PII], first initial and my last name is [PII].
[AGENT][POSITIVE] And [PII], it was a pleasure to assist you with that claim information, especially when I understood the provider name. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] No, ma'am, that was it.
[AGENT][POSITIVE] Hello, thank you for calling APL. I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] You do the same.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Mm bye bye.