AccountId: 011433970860
ContactId: 3cb9231b-662b-4ba9-9744-61d91ff7ddd3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 356989 ms
Total Talk Time (AGENT): 117538 ms
Total Talk Time (CUSTOMER): 106763 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/3cb9231b-662b-4ba9-9744-61d91ff7ddd3_20250109T16:11_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEGATIVE] Yes, hi, um, um, I, I received, uh, a, um, a thing that I owe the hospital $870 that you only paid $130. Um, uh, Blue Cross Blue Shield processed and it left a $1000 balance and it was sent to you and you only paid $130 and I wanna know why usually you pay it all.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I can check and see. Um, what is the policy number?
[CUSTOMER][NEUTRAL] Um, this is, I don't know if it's the same one because it, I mean, it's just gets renewed every year, but it says uh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, I guess group number?
[AGENT][NEUTRAL] It's gonna be the policy search or if you're looking at the explanation of benefits, it's gonna be the reference number.
[CUSTOMER][NEUTRAL] No, I don't have anything with me. I just have a I just have my, my ID card.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So it's gonna be the policy er in the bottom of the card?
[AGENT][NEUTRAL] Outpatient.
[CUSTOMER][NEUTRAL] It doesn't say that. It says, uh, insured coverage group number, effective date plan.
[CUSTOMER][NEUTRAL] In hospitals benefit, outpatient benefit, that's it.
[AGENT][NEUTRAL] Outpatient benefits.
[CUSTOMER][NEUTRAL] You want that number?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, patient benefit cer certification number [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Let me have a call back number just in case we get disconnected.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and may I have your name and date of birth for security?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you and I need to verify your mailing address and email address on file.
[CUSTOMER][NEUTRAL] [PII] and the email is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Let me check this group really quick. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and let's see.
[CUSTOMER][NEUTRAL] Did you find my account?
[AGENT][NEUTRAL] I did, I did. It's, it's a different account, um.
[AGENT][NEUTRAL] But I located through the group, so let me just go ahead and go over the benefits now and what is the date of service on that claim?
[CUSTOMER][NEUTRAL] Oh, I don't even know. I think it was.
[CUSTOMER][NEUTRAL] Jesus, um.
[CUSTOMER][NEUTRAL] I don't know. I think it was the [PII].
[AGENT][NEUTRAL] Is it for Memorial Memorial Hospital Miramar?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, alright, let me pull this for you.
[AGENT][NEUTRAL] And
[CUSTOMER][NEGATIVE] I know they, they, they sent $1000 they didn't cover $1000 and and then they billed you guys and you guys only paid $130.
[AGENT][NEUTRAL] OK. Yeah, it looks like um the reason for that payment is because you exhausted the benefit for that year for outpatient service, but let me double check just to make sure, OK?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. Yes. Uh, with the payment of that check, the maximum outpatient benefit has been exhausted for the year. So that 130 is the only amount you had available at the time we received that claim for outpatient.
[CUSTOMER][NEUTRAL] So now, OK, so I have to pay that and then like I'm getting an MRI tomorrow that you, you'll cover that.
[AGENT][NEUTRAL] Um, the, yeah, the year started, yeah, the year started all over again this year, so the benefits started with the year. Um, so right now, and this is not a guarantee of payment, just a verification of coverage, but you have the um outpatient maximum of 3000 per year.
[CUSTOMER][NEUTRAL] For this year?
[CUSTOMER][POSITIVE] OK, alright, thank you.
[AGENT][NEUTRAL] You're welcome. Is there anything else I may help you with today, [PII]?
[CUSTOMER][POSITIVE] That's it, thank you.
[AGENT][POSITIVE] You're welcome and thank you for calling APO. Have a good day, Ms. [PII] Bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.