AccountId: 011433970860
ContactId: 4ded0a09-c907-4cb4-b397-6d9802d21f4f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 193100 ms
Total Talk Time (AGENT): 95874 ms
Total Talk Time (CUSTOMER): 53510 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/4ded0a09-c907-4cb4-b397-6d9802d21f4f_20250128T16:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] with Meritt Health River Oaks. I was calling to see if I could get a few few details about a client, please.
[AGENT][NEUTRAL] Sure I can help you with the claim details. [PII] you say [PII], correct?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And may I please have your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and do you have the policy certificate or member ID number please?
[CUSTOMER][NEUTRAL] Yes, we have 02506719.
[AGENT][POSITIVE] OK, thank you, just give me one moment please.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And may I please have you verify a patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, [PII] [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And do you have a claim number, [PII], do you, do you need to look it up or data service?
[CUSTOMER][POSITIVE] Yes, I do.
[CUSTOMER][NEUTRAL] I, I have a claim number. It's 353-3385.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, just give me one moment please.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] OK, it looks like it's for data service [PII].
[CUSTOMER][NEUTRAL] Yes, that's yeah.
[AGENT][NEUTRAL] OK, and how can I help you? What's your question there?
[CUSTOMER][NEUTRAL] Um, I see that you guys paid $550. I'm just trying to see what the remainder is it's discounted or patient responsibility.
[AGENT][NEUTRAL] OK, so this, uh, this policy is a limited medical hospital indemnity, [PII], so it does pay limited medical benefits and it does appear that um it looks like it was an emergency room visit. We paid a $350 benefit for the emergency room visit and then we paid an additional benefit for that uh major diagnostic. It looks like a CAT scan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So that is the maximum allowed under this plan. um, now because it is limited in uh hospital indemnity we do not make any adjustments to that balance, so the balance would be between the facility and the patient. We don't determine that liability because there's no uh contract there's no adjustment made to the, uh, claim and we pay the benefits based on what their policy allows.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's what we do need to double check just to make sure it wasn't discounted through our network or anything like that.
[AGENT][NEUTRAL] Did you have any additional questions [PII]?
[CUSTOMER][NEUTRAL] Nope, that's everything.
[AGENT][POSITIVE] Alright, well thank you so much for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] You too. Thank you.
[AGENT][POSITIVE] Thank you bye bye.
[CUSTOMER][NEUTRAL] Bye bye.