AccountId: 011433970860
ContactId: 376beded-e7ca-4d4e-ac9a-4bd4ff646d74
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 320049 ms
Total Talk Time (AGENT): 133840 ms
Total Talk Time (CUSTOMER): 91131 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/376beded-e7ca-4d4e-ac9a-4bd4ff646d74_20241230T21:16_UTC.wav
--------------------------------------------
[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 for claim status, um.
[CUSTOMER][NEUTRAL] I have a feeling this is a limited plan for this member um just need to confirm.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the policy type and the claim status, and [PII], may I have a good contact number in case we're disconnected and then the policy number?
[CUSTOMER][NEUTRAL] Yes, it's [PII]. It's a direct line.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, the policy number.
[CUSTOMER][NEUTRAL] Uh, let's see, we'll go back to this other tab.
[CUSTOMER][NEUTRAL] 02331051 for [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Thank you for that, and I have the policy here and I just need you to verify his date of birth.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And um so yes, this is the hospital indemnity policy, so it is a limited medical policy, um, but what claim did you want me to check for you, the date of service?
[CUSTOMER][NEUTRAL] Um, the data service is.
[CUSTOMER][NEUTRAL] For [PII], it is for ER.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And what's the total bills? This one.
[CUSTOMER][NEUTRAL] Uh, total bill is 11, let's see, $11,288.49.
[AGENT][NEUTRAL] OK, here it is. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 4431.
[AGENT][NEUTRAL] Here it is, so we received the claim on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, that claim number is 3294431.
[AGENT][NEUTRAL] I'm sorry, I flipped it. We received it on [PII]. On [PII], it was processed, my apologies.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] What was it the night for?
[AGENT][NEUTRAL] Let's see
[AGENT][NEUTRAL] The outpatient rider only allows payment for outpatient surgery in an outpatient hospital or physician office. Therefore, no benefits are payable.
[CUSTOMER][NEUTRAL] OK, and is there a claim number?
[AGENT][NEUTRAL] Yes, it's 329.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 4431.
[CUSTOMER][NEUTRAL] Oh, that's the other number you gave me. OK, um, let's see here.
[CUSTOMER][NEGATIVE] You said it denied for um.
[CUSTOMER][NEUTRAL] What was the specific reason?
[AGENT][NEUTRAL] Um, the outpatient rider only allows payment for outpatient surgery.
[AGENT][NEUTRAL] In an outpatient hospital or physician office.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there a way you can fax me over that um
[CUSTOMER][NEUTRAL] That EOB
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And do I need to put attention, [PII]?
[CUSTOMER][NEUTRAL] No, it comes directly to me, um, 6.
[AGENT][NEUTRAL] OK, and that was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so I'll go ahead and fax this over to you now and again, all the information provided was a verification of benefits, not a guarantee of payment. And [PII], was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Um, no. Does, does the EOB state that it's patients responsibility by chance?
[AGENT][NEUTRAL] It will not, um, we don't determine patient responsibility, so it won't be on the EOB. If there is an outstanding balance, uh,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Then it will be between the provider or if they do have a primary.
[CUSTOMER][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Call reference number.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. So that's [PII].
[CUSTOMER][POSITIVE] OK, perfect. Thank you so much.
[AGENT][POSITIVE] You're welcome, [PII], and thanks for calling APL and I hope you have a great day and happy New Year.
[CUSTOMER][POSITIVE] Happy New Year to you too. Thank you. Bye-bye.
[AGENT][POSITIVE] You're welcome. Bye-bye.