AccountId: 011433970860
ContactId: 35085454-11e2-42af-909f-3fe6ceee64d5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 576960 ms
Total Talk Time (AGENT): 178737 ms
Total Talk Time (CUSTOMER): 92363 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/35085454-11e2-42af-909f-3fe6ceee64d5_20250310T18:26_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] Hi, [PII]. My name is [PII] and I'm calling from the provider's office to check on a claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, the member ID is 0254.
[CUSTOMER][NEUTRAL] 7209.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure. Uh, the patient's name is [PII] and the date of birth is
[CUSTOMER][NEUTRAL] [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 and the total bill for the claim?
[CUSTOMER][NEUTRAL] Sure. Uh, the date of service is [PII].
[CUSTOMER][NEUTRAL] And the total bill amount is.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Yeah, so the total bill amount is $628.34.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The facility's name is Mary Hitchcock Memorial Hospital.
[AGENT][NEUTRAL] OK, hold on one moment because we received this a few times, so hold on one second.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold while I take a look at the claims?
[CUSTOMER][NEUTRAL] Sure [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, wait, so 585. Let's start from the beginning. So really that's end.
[AGENT][NEGATIVE] I'm just gonna put them all down.
[AGENT][POSITIVE] Wow, very far.
[AGENT][NEGATIVE] This is HI. It's not gonna give me a total bill.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh, so on 33 that's all it was.
[AGENT][NEUTRAL] It's just these two.
[AGENT][NEUTRAL] It's 9684.
[AGENT][NEUTRAL] I mean, it's not 464.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] 8029.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] So we have 3 claims with
[AGENT][NEUTRAL] I have 2 clients with the 6, OK.
[AGENT][NEUTRAL] So it is.
[AGENT][NEUTRAL] This one
[AGENT][NEUTRAL] And this one.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][POSITIVE] Yes [PII] I'm you.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So, I, um, we received the claim twice. Did you need the original or would you like both?
[CUSTOMER][NEUTRAL] Uh, yeah, I can, you can provide me the original claim status.
[AGENT][NEUTRAL] OK. Um, so we received the claim on [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Claim number is 355-0633.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] And actually,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hold on one second. What's the difference?
[AGENT][NEUTRAL] So actually,
[AGENT][NEUTRAL] You can disregard that. The insured submitted that. Let me give you the
[AGENT][NEUTRAL] That's the difference between the two. The insured submitted one and the other the provider submitted. Um, so, your claim was received on [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3563585.
[CUSTOMER][NEUTRAL] Uh huh
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because the policy provides no benefits for treatment other than defined in the policy by sickness and injury.
[CUSTOMER][NEUTRAL] So this is a non-covered service as for the plan.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. So, uh, can we like, uh, go ahead and build the members for, for the 9?
[AGENT][NEUTRAL] Well, we don't provide patient responsibility because we're not a major medical insurance company, um, so that would be whatever your procedures are.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so is there any discount that we can, uh, like after the discount, can we build the member or can we bill the entire amount to the member?
[AGENT][NEUTRAL] Again, we don't determine patient responsibility. So it would be whatever your company's policies are on outstanding or remaining balances.
[CUSTOMER][NEUTRAL] All right. And what plan does the patient have?
[AGENT][NEUTRAL] This is the hospital indemnity policy. It's a limited medical policy.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] And so finally can I have a call reference number for this call [PII].
[AGENT][NEUTRAL] Sure, 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] All right, [PII] and thank you so much for assisting with this claim today. You have a great day. Bye for now.
[AGENT][POSITIVE] Thank you for calling APL and I hope you have a great day as well. Bye-bye.