AccountId: 011433970860
ContactId: 41b4b359-0286-43f7-ba32-e24828cfbac5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 273570 ms
Total Talk Time (AGENT): 135912 ms
Total Talk Time (CUSTOMER): 82035 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/41b4b359-0286-43f7-ba32-e24828cfbac5_20250429T18:19_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from a provider's office, North Memorial Health, and I just need to check the status to see if a claim was received. I'm I'm able to locate it.
[AGENT][NEUTRAL] Sure, yeah, I can look on that claim for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] direct and secure.
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Um, yes, I think it's 02567481.
[AGENT][NEUTRAL] OK, and what was the name and date of birth for the member, please?
[CUSTOMER][NEUTRAL] Um, I have a name of [PII], [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that and what was the date of service for this claim?
[CUSTOMER][NEUTRAL] You know, a data service of [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, 35336. I was not expecting that. I'm sorry, that was really funny. um, what was that, um, do you have the total bill amount?
[CUSTOMER][NEUTRAL] Yes, I have a total charge amount of $5480.06.
[AGENT][POSITIVE] OK, got it. Thank you. One moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, you did say this was North Memorial Health?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so looks like we did receive this claim um it looks like there were a couple of items on this claim there was another item for.
[AGENT][NEUTRAL] $4,651 as well on the same claim.
[AGENT][NEUTRAL] Does that sound right to you?
[CUSTOMER][NEUTRAL] Um, yes.
[AGENT][NEUTRAL] OK, so for uh the total benefit amount that we paid was $550. We paid $500 on the, uh, I think it's hospital and the other one is room and board, is that right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, yeah, so we paid $500 for the hospital, uh, $50 for room and board. Um, this is a limited indemnity medical plan, so those amounts are simply the maximum, uh, for each, uh, covered procedure and be um office visit, things like that. That's the maximum amount. Um, if you'll give me one moment, I will get that.
[CUSTOMER][NEUTRAL] To
[AGENT][NEUTRAL] Check information for you. Did you need that claim number first?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, that is 35.
[AGENT][NEUTRAL] 82
[AGENT][NEUTRAL] 691.
[AGENT][NEUTRAL] I can also send you a copy of the EOB if you'd like.
[CUSTOMER][POSITIVE] Thank you and then the.
[CUSTOMER][NEUTRAL] No, I think, I think I should be fine just with that information that I have. um, I just need to clarify, so with the remaining balance of the, um, billed amount, would that be um provider liability or patient responsibility?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] So we do not say what is patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alrighty, um, and then I actually think that's all I need. I do see the payment details as pending for us.
[AGENT][NEUTRAL] Did you need the check number or anything?
[AGENT][NEUTRAL] Oh, OK, yeah, I am showing.
[CUSTOMER][NEUTRAL] Um, is that, can you just come, yeah, I think we have it.
[AGENT][NEUTRAL] OK, yeah, I'm showing it was issued, um, [PII] and it has not yet cleared, so if, um, we do have a or if after 30 days of that issue date if it has not yet cleared or y'all haven't received it, uh, you can give us a call and we can get it voided and reissued.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][POSITIVE] Alrighty, and I think that's actually all I need if I can just have a call reference number for today.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, that would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII] And was there anything else I could help you with, sir?
[CUSTOMER][POSITIVE] No that is I'll take care.
[AGENT][POSITIVE] Alright, thanks for giving us a call you too bye bye.
[CUSTOMER][NEUTRAL] Mm bye bye.