AccountId: 011433970860
ContactId: 2dfca56d-86bf-4e53-93fd-464728522767
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 465609 ms
Total Talk Time (AGENT): 177634 ms
Total Talk Time (CUSTOMER): 99396 ms
Interruptions: 2
Overall Sentiment: AGENT=1.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/2dfca56d-86bf-4e53-93fd-464728522767_20250521T18:09_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] at Scotland Memorial Hospital. Um, I was calling to check on the status of a claim.
[AGENT][NEUTRAL] OK, well you're needing to check claim status for number, is that correct?
[CUSTOMER][NEUTRAL] Yes, mhm.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And what is a good callback number for you please?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][POSITIVE] Thank you and the member's policy number please.
[CUSTOMER][NEUTRAL] Um, 02505206.
[AGENT][NEUTRAL] OK, thank you. One moment while I get the member's information pulled up.
[AGENT][NEUTRAL] And 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] [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for him, please?
[CUSTOMER][NEUTRAL] Data service was [PII]. Total charges were $2,049.75.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEUTRAL] Sorry I can't.
[CUSTOMER][NEUTRAL] that the same thing.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] All right, I'll give me just a couple of moments. I'll I've got to try to look up some information.
[CUSTOMER][NEUTRAL] I should check.
[CUSTOMER][NEUTRAL] OK mhm.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah you did.
[CUSTOMER][NEUTRAL] I thought.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I'm sleepy. I'm out here drinking caffeine, eating chocolate, not chocolate.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] OK, [PII], it looks like this claim was received on [PII].
[AGENT][NEUTRAL] And it was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is going to be 3555328.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry, could you repeat that for me?
[AGENT][NEUTRAL] Sure. 355-5328.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There was a benefit paid in the amount of $26.80.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That was on single check 202-400-007.
[AGENT][NEUTRAL] It does show that that check did clear on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the remarks on this claim.
[AGENT][NEUTRAL] I have to go back and forth. I'm sorry, that's why there's a pause and what I'm in the information I'm giving you. OK, so on.
[CUSTOMER][NEUTRAL] No, that's fine. I understand.
[AGENT][NEUTRAL] Oh, on.
[AGENT][NEUTRAL] The ER, it shows if during this hospital confinement you required services of a physician other than a surgeon, please submit the itemized bill for our review.
[AGENT][NEUTRAL] And the benefit that was paid was paid on the $294 charge.
[CUSTOMER][NEUTRAL] OK, and I think.
[AGENT][NEUTRAL] For the procedure, 12001. Mhm.
[CUSTOMER][NEUTRAL] On the $294 charge.
[AGENT][NEUTRAL] That's what the 2680 was paid on and that states with this check the maximum benefit payable for this data service has been met.
[CUSTOMER][NEUTRAL] 200
[CUSTOMER][NEUTRAL] OK, and because this is a limited hospital indemnity plan that means like ER services are unnecessarily covered.
[AGENT][NEUTRAL] Let me pull up the policy information to look at how this is worded on this one.
[AGENT][NEUTRAL] All of these are a little different, so give me just a second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that is correct. It does not show emergency room benefits.
[CUSTOMER][NEUTRAL] OK, OK, um, was there any patient responsibility at all?
[AGENT][NEUTRAL] We do not determine patient responsibility. All of that would be up to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, and can I get a reference number for the phone call?
[AGENT][NEUTRAL] Yes ma'am, you would use my name along with today's date.
[AGENT][NEUTRAL] And then oh we also have a [PII], uh huh and then we have a portal that you should be able to check. I'm sorry to have access to the EOB in and the website for that portal is secured. [PII].
[CUSTOMER][NEUTRAL] OK, you said your name is [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. Now do I need to create like a provider log in or?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] You would, you would, yes, it's a self-registering portal, so yes, you would.
[AGENT][NEUTRAL] Create a profile.
[CUSTOMER][POSITIVE] OK all right thank you.
[AGENT][POSITIVE] Well, you're welcome. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] No, ma'am, that was it.
[AGENT][POSITIVE] OK, well thank you again for calling APL and I hope you have a great afternoon.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Uh bye.