AccountId: 011433970860
ContactId: 35793f51-aa76-49fc-b950-feb94832e2dd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 428019 ms
Total Talk Time (AGENT): 134168 ms
Total Talk Time (CUSTOMER): 129181 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/35793f51-aa76-49fc-b950-feb94832e2dd_20250417T14:26_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL this is [PII] how may I help you?
[CUSTOMER][NEUTRAL] I'm checking on uh claim status, please, on the patient.
[AGENT][NEUTRAL] OK, I, yes, I can help you with claim status. Can you please give me your name, your callback number, and the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Yes. [PII]
[CUSTOMER][NEUTRAL] Uh, my phone number [PII].
[CUSTOMER][NEUTRAL] And first name is [PII].
[AGENT][NEUTRAL] OK, thank you very much. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] [PII], [PII] 02434552.
[AGENT][NEUTRAL] OK, let me look up that policy real quick.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] OK, and may I please get the date of service and the charge amount?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] OK, thank you. Let me look that up real quick.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, it's trying to pull in for me now. It's gonna be just a second.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I am showing that the claim was paid. Let me give you the claim number.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It is 358-4875.
[AGENT][NEUTRAL] The claim was paid $50 with check number.
[AGENT][NEUTRAL] 2037087. With this check, the maximum benefit payable for this state of service has been met.
[CUSTOMER][NEUTRAL] Uh, only 50 for 4 CPT codes.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] This is a hospital indemnity plan has a set amount.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] For covered procedures per day and the maximum is $50.
[CUSTOMER][NEUTRAL] You don't
[CUSTOMER][NEUTRAL] Uh, so per day, no matter what we do, so she cannot be seen in the doctor's office, only in the hospital?
[AGENT][NEUTRAL] No, she was seen and it was paid $50 which is the maximum benefit for the day.
[CUSTOMER][NEUTRAL] OK. So each day they only can pay $50. There is no more than that at all.
[AGENT][NEUTRAL] Correct. Right. It's a set amount for a covered procedure. It's an indemnity plan.
[CUSTOMER][NEUTRAL] How do you spell indemnity?
[AGENT][NEUTRAL] I N.
[CUSTOMER][NEUTRAL] And then
[AGENT][NEUTRAL] I N D E M I N T Y.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I identity plan.
[CUSTOMER][NEUTRAL] So if she comes 5 consecutive days for different days, so every day is $50 or like per week, $50. How does, can you please tell me a little bit more about it?
[AGENT][NEUTRAL] OK, let me look real quick at our benefits.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] She gets 4 visits per year.
[AGENT][NEUTRAL] That pays $50.
[CUSTOMER][NEUTRAL] For any visits, like ultrasound visits, any doctors or any 4 visits, only $50. That, that is what her insurance is?
[CUSTOMER][NEUTRAL] That covers only that much?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] And that's the only benefit she has. Is there any other benefits that I need to know?
[AGENT][NEUTRAL] No, ma'am, the, the claim was processed and paid for her policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you so much. I didn't know about that. Uh, can I please have your name and the reference number?
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Yes, you can use my name which is [PII] and today's date.
[CUSTOMER][NEUTRAL] Oh, and if she goes to the hospital, and if she goes to do a big procedure, they still pay $50?
[CUSTOMER][NEUTRAL] Maximum per day?
[AGENT][NEUTRAL] No, she has different different benefits for hospital. No, she has different benefits for hospital admission for 18 hours or more.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, OK. So this one you gave me was uh for medical, right? Just medical office visits?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] I see. OK, great. Thank you so much. Have a good day. Bye-bye.
[AGENT][POSITIVE] You're very welcome you have a wonderful day too, and thank you for calling APL bye bye ma'am.
[CUSTOMER][POSITIVE] Thank you. Bye-bye