AccountId: 011433970860
ContactId: 2d013ad0-7aab-4c9b-93f4-7d546b8a35d3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 485160 ms
Total Talk Time (AGENT): 203799 ms
Total Talk Time (CUSTOMER): 66210 ms
Interruptions: 1
Overall Sentiment: AGENT=2.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/2d013ad0-7aab-4c9b-93f4-7d546b8a35d3_20250401T17:19_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] You said I'm sorry, can I have your name again?
[AGENT][NEUTRAL] Oh, it's [PII]
[CUSTOMER][NEUTRAL] Yes, my name is [PII], um, with Aiken Regional Medical Center calling to get claim status.
[AGENT][POSITIVE] OK [PII], I'd love to help you with claim status today. Do you mind if I quickly grab a good callback number just in case the call gets disconnected?
[CUSTOMER][NEUTRAL] Yes, direct number is [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII]. And what is the policy number we want to look at for the claim today?
[CUSTOMER][NEUTRAL] 02038519
[AGENT][NEUTRAL] Sorry, 020385. What was the last of it?
[CUSTOMER][NEUTRAL] 19
[AGENT][POSITIVE] 19 thank you I appreciate that. Give me a moment to get that pulled up for you.
[AGENT][NEUTRAL] Thank you. And if you could verify for me, please, your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and the bill amount where I'm wanting to look at for Mr. [PII] today?
[CUSTOMER][NEUTRAL] Give me a second.
[AGENT][POSITIVE] No worries. Take your time.
[CUSTOMER][NEUTRAL] 1216 24.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] $9,0004.
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] And would you please verify for me, I think you said it when you called, but uh the name of the facility on file again.
[CUSTOMER][NEUTRAL] Aiken Regional Medical Center.
[AGENT][POSITIVE] Thank you. I really appreciate that. And I do see your claim here. It looks like we received the claim on [PII]. We processed the claim, pardon me, processed the claim on [PII].
[CUSTOMER][NEUTRAL] Oh hold on.
[AGENT][NEUTRAL] Um, I have your claim number listed is 3549. 0, I'm so sorry.
[CUSTOMER][NEUTRAL] Hold on hold on hold on hold on please.
[CUSTOMER][NEUTRAL] OK, what's the claim number?
[AGENT][NEUTRAL] Yes, absolutely. Um, 354-922-1.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it looks like that claim had benefits payable of $75 that were paid via check. I have the check number listed as 202-213-3.
[CUSTOMER][NEUTRAL] Any patient responsibility.
[AGENT][NEUTRAL] Um, this is a supplemental policy, so we can't determine patient responsibility.
[CUSTOMER][NEUTRAL] OK, we sent you all, um, like a underpayment ration letter. Can you tell me if you received that and the status of that?
[AGENT][POSITIVE] OK, absolutely.
[AGENT][NEUTRAL] Alright, so I do see that we did receive your letter. It looks like we received it the end of [PII], and it does look like a decision was made and delivered via fax to [PII].
[CUSTOMER][NEUTRAL] Hold on, hold on.
[CUSTOMER][NEUTRAL] Hold on for a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The fax to what number?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, um, can you tell me what the decision was?
[AGENT][NEUTRAL] Yes, um, so it says upon review of your claim, it has been determined that the claim was processed correctly in accordance with the policy contract. The hospital indemnity insurance plan under which Mr. [PII] is covered, is not a major medical plan, but instead a hospital indemnity insurance plan.
[AGENT][NEUTRAL] This policy is a HIPAA um accepted benefit and therefore not subject to many Public Health Service Act requirements, including the mandates imposed by the healthcare reform. Benefits payable under this policy are not based on reasonable and customary, in and out of network, RAP provisions or unit values. Benefits are payable based upon the applicable policy provisions. The facility claim for this um.
[CUSTOMER][NEUTRAL] Could you fax that
[AGENT][POSITIVE] Oh, I can fax that again for you, you bet you.
[CUSTOMER][NEUTRAL] I'm gonna give you another number.
[AGENT][POSITIVE] OK, yeah, absolutely. Let me pull up the fax document real fast.
[AGENT][POSITIVE] And I will get that sent your way.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And who can I make that attention to?
[CUSTOMER][NEUTRAL] I'm [PII].
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And the fax number?
[CUSTOMER][NEUTRAL] Um [PII].
[AGENT][NEUTRAL] 930. I have it going to attention [PII] at [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Perfect. Alrighty, I'm hitting send on that fax as long as it doesn't kick back, um, it should come through within the next 5 to 15 minutes.
[CUSTOMER][NEUTRAL] OK, is there a call reference number for me?
[AGENT][NEUTRAL] Yeah, it's just my name [PII] My last initial B like boy and today's date.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] It's my pleasure. Is there anything else I can do to take care of you today, ma'am?
[CUSTOMER][NEUTRAL] That's it.
[AGENT][POSITIVE] All righty. So I hope you have such a fabulous Tuesday and you take care, Miss [PII].
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][POSITIVE] My pleasure. Bye bye.