AccountId: 011433970860
ContactId: 51f6e3d3-e630-41c0-bb44-5951dbe07f5e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 373309 ms
Total Talk Time (AGENT): 145070 ms
Total Talk Time (CUSTOMER): 101197 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/51f6e3d3-e630-41c0-bb44-5951dbe07f5e_20250312T14:03_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning [PII]. My name is [PII]. I'm calling from Mercy Hospital. I am trying to um.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] A patient presented in December for an emergency room visit, but they didn't present with their insurance card you all paid on it. I'm trying to figure out how this claim paid so I need to know if.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] I'm so sorry. Do you mind holding for one second?
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] For me, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] [PII], I am so sorry about that. I was having trouble with one of my screens. So you said that you had a claim that you're wanting to follow up on the claim status on because we did pay that, is that correct? There was a claim that was processed?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It was a claim that was processed and I just need to know what's on and you all paid on it too, but I need to know what's on that insurance card, how this claim was processed.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If it was processed with PHCS, what's on the card if this is a limited benefit plan or if it's an ancillary plan.
[AGENT][POSITIVE] Yes ma'am, I can tell tell you what type of plan it is. I can help you with that. And what is your callback number, [PII]?
[CUSTOMER][NEUTRAL] Direct line no extension [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] 02501880.
[AGENT][POSITIVE] OK, thank you one moment please.
[AGENT][NEUTRAL] OK, any information that I provide for you, [PII] will be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you. And the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] [PII] build amount $9,486.34.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, thank you. And do you have the claim number?
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Yes, we have 354-69009.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] OK, so let me see.
[AGENT][NEUTRAL] OK, so yes, I do show that there was a $150 benefit paid.
[AGENT][NEUTRAL] On this limited benefit plan.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And the remarks that are on here.
[AGENT][NEUTRAL] One states with this check, the maximum benefit payable for this state of service has been met.
[AGENT][NEUTRAL] And then on the diagnostic, it states the calendar, your maximum for this benefit has been exhausted with the payment of this claim.
[CUSTOMER][NEUTRAL] OK, um, can I get this member's effective and term date if any?
[AGENT][NEUTRAL] You can. The effective date is going to be [PII].
[AGENT][NEUTRAL] And the there is no term date. This policy is still currently showing as active.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, [PII], can I get the correct spelling of your first name, last initial, and a call reference number, please?
[AGENT][NEUTRAL] Sure, the, um, my name is [PII] The first initial to my last name is [PII], and my name along with today's date would be uh your call reference number.
[CUSTOMER][POSITIVE] All right, thank you so much for your time.
[AGENT][NEUTRAL] Well, you are certainly very welcome and if you need a copy of this explanation of benefits we do have a portal that you should be able to print that from, and that portal website, [PII] is located at [PII] and it is a self registering portal.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, well, if that is all I can help you with, thank you again for calling APL and again thank you for holding for me when we initially got on our call. So I hope you have a a very nice day.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] Uh, no problem.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Bye.