AccountId: 011433970860
ContactId: 513361a9-5500-4419-bba1-d925d902f347
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 441910 ms
Total Talk Time (AGENT): 132174 ms
Total Talk Time (CUSTOMER): 113187 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/513361a9-5500-4419-bba1-d925d902f347_20250102T13:32_UTC.wav
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[AGENT][POSITIVE] Good morning thank you for calling. My name is.
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling on behalf of provider office to check on our claim status. How are you doing today?
[AGENT][POSITIVE] I'm doing well, thank you for asking. How are you today?
[CUSTOMER][POSITIVE] I'm doing great, thank you for asking. And could you please spell your name for me?
[AGENT][NEUTRAL] My name is [PII]. And do you mind spelling your name also for documentation?
[CUSTOMER][NEUTRAL] Sure. It is [PII] is my last name.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the callback number, please?
[CUSTOMER][NEUTRAL] OK. That's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] OK. The policy number is 02455343.
[AGENT][NEUTRAL] Thank you, and the patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK. The patient name is [PII].
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][POSITIVE] All right, thank you. I do have the policy pulled up for Renee, and how can I help you today?
[CUSTOMER][NEUTRAL] OK. I got a claim stated and it is for a beneficiary maximum for the date of service.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It has been noted.
[CUSTOMER][NEUTRAL] And may I know the allowed amount for that?
[AGENT][NEUTRAL] What's the claim number?
[CUSTOMER][NEUTRAL] OK. The claim number is 3532692.
[CUSTOMER][NEUTRAL] No, I still look at you.
[AGENT][NEUTRAL] 353-269-2
[AGENT][NEUTRAL] Alright if you'll give me just one moment, I'll get that benefit amount now we don't reprice claims.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] We're not major medicals, so it just depends on the benefit amount.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this looks like it was for an emergency room visit?
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] Yeah, and
[CUSTOMER][NEUTRAL] Could you please repeat that? I can't hear you.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] I was stating that we do not reprice claims.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] But I can give you the benefit amount allowed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm just getting that pulled up. Bear with me just one moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] It's coming up slowly, so bear with me.
[CUSTOMER][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] I do apologize.
[AGENT][NEUTRAL] For emergency room, the benefit amount is $150 per day, and that is payable two days per calendar year. Now that is a verification of coverage and not a guarantee of payment.
[AGENT][NEUTRAL] Anything else I can help you with?
[CUSTOMER][NEUTRAL] OK. Uh,
[CUSTOMER][NEUTRAL] Yes, um, as per the, as for my software, it is an out of network provider. May I know how it is, uh, maximum beneficiary?
[AGENT][NEGATIVE] The there's no network on this policy.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] It's not considered out of network, it's just the maximum benefits were paid for that data service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, doctor, may I know the provider is not contracted with you?
[AGENT][NEUTRAL] There's no network on this policy?
[AGENT][NEUTRAL] So they can go to any provider.
[CUSTOMER][NEUTRAL] OK. One minute.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK. May I know the number plan type?
[AGENT][NEUTRAL] It's a limited hospital indemnity policy.
[CUSTOMER][NEUTRAL] OK. May I know it is BPO or HMO?
[AGENT][NEUTRAL] Neither, it's just a limited indemnity policy.
[CUSTOMER][NEUTRAL] OK, one minute.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] OK. May I know, it is an open network?
[AGENT][NEUTRAL] Yes it is.
[CUSTOMER][NEUTRAL] OK. Uh, thanks. OK, thank you for your time and assistance. And can I get the call reference number?
[AGENT][POSITIVE] The call reference is my name and today's date, and I spell my name [PII] initial [PII] my last name is [PII], it was a pleasure to assist you with that claim status. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, thank you for your time and assistance. Have a great day. Bye-bye.
[AGENT][POSITIVE] And thank you for calling APL. Hope you have a great day as well. Take care. Bye-bye.