AccountId: 011433970860
ContactId: 55264a11-8fa9-43da-9b17-8e7b4f02fc43
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 894250 ms
Total Talk Time (AGENT): 216818 ms
Total Talk Time (CUSTOMER): 109261 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/55264a11-8fa9-43da-9b17-8e7b4f02fc43_20250130T15:09_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I am calling from Baptist Medical. I'm calling regarding a claim for a patient.
[AGENT][NEUTRAL] OK, Miss [PII], I can help you with the claim. Can I please get your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then what is the patient's name?
[CUSTOMER][NEUTRAL] [PII] at the end.
[AGENT][NEUTRAL] OK, and what is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then the policy number please?
[CUSTOMER][NEUTRAL] 02239617
[AGENT][POSITIVE] Thank you, let me pull in that policy real quick.
[AGENT][NEUTRAL] OK, and then what is the data service?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And the charge amount please?
[CUSTOMER][NEUTRAL] $6,868 even.
[AGENT][NEUTRAL] OK, thank you. I'm gonna put you on a brief hold, Miss [PII], while I look up this claim for you and I'll be right back.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi Ms. [PII], this is [PII]. So I have the information you need. Good, um, the the claim number is 344-0424. It was paid with check number 1846311. The check has cleared and the of $250 and after um.
[CUSTOMER][NEUTRAL] Hi how are you?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] This payment was made it exhausted the benefit for the under year for the insured.
[CUSTOMER][NEUTRAL] Are you guys primary or secondary?
[AGENT][NEUTRAL] Major medical insurance. This is a limited hospital indemnity plan.
[CUSTOMER][NEUTRAL] Oh, it's an ER OK so.
[CUSTOMER][NEUTRAL] How many ERs does he get per per year under this policy?
[AGENT][NEUTRAL] Let me check for you.
[AGENT][NEUTRAL] OK, I'm gonna have to pull the policy in so it's gonna be a moment for the computer to doubt it.
[CUSTOMER][POSITIVE] Thanks.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] It's trying to load now.
[AGENT][NEUTRAL] It's gonna be a little bit because I have to read through the policy and see what it says about ER.
[CUSTOMER][POSITIVE] Yeah, you know what, you don't worry about it. I, I, you don't have to go through all that extreme, um, so here's a quick question, we have sent an appeal.
[CUSTOMER][NEUTRAL] I guess under payment appeal, can you tell me if you guys received it?
[AGENT][NEUTRAL] Uh, let me look and see if there's anything on here that says anything about an appeal. Do you know when you sent it in?
[CUSTOMER][NEUTRAL] Um, let's see, it was mailed out on [PII]?
[AGENT][NEUTRAL] Let me look at this one.
[AGENT][NEGATIVE] I received something on [PII] but I can't see exactly who it was from um I don't have the capability on my computer to be able to see that I have a limited amount of what I can see.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But there was something received at you claim form on [PII].
[CUSTOMER][NEUTRAL] So you can't see if it was upheld denied.
[AGENT][NEUTRAL] No ma'am, I can't see that information. Now I can get your number and well I've already got your number [PII] and put in a request for somebody to turn the call and let you know what the status of the appeal is.
[AGENT][NEUTRAL] Would you like for me to do that?
[CUSTOMER][NEUTRAL] What's your time and filing for an appeal?
[CUSTOMER][NEUTRAL] Well, here's the question. What's your time is silence?
[AGENT][POSITIVE] The timely filing.
[AGENT][NEUTRAL] It is 180 days from the date of the claim when it was initially processed and we'll need a letter as to why the the claim is being appealed.
[CUSTOMER][NEUTRAL] I mean I hope that was all sent with it.
[CUSTOMER][NEUTRAL] Oh [PII], alright, yeah, so let's, no, I know, uh, we don't know what was sent, but anyway, um, alright, so, um, let's get a call back and then, so since you guys have paid the $250 is the patient responsible for the remaining?
[AGENT][NEGATIVE] Oh no, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] We don't give yeah we don't give patient responsibility because that's determined by the provider but I do know that once that $250 was claim that was paid, the benefits for the calendar year were exhausted, so they had used all their benefits for that year with that $250 payment, which means there could have been clients before you guys, you know, filed yours.
[CUSTOMER][NEUTRAL] Or do you guys provide a discount?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, yeah, OK, I see, um, alright, yeah, I guess, you know, just, just if you can just have them either call me, leave a message if it was received, if it was upheld or it's been since October so I'm assuming that it's something.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am yes ma'am I will make sure I get that I'm gonna put you on hold while I get that together um while we're on the phone to get so I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding [PII]. I've got that hub request in for you to be able to get a call back about the appeal status on claim number 344-0424.
[CUSTOMER][POSITIVE] Thank you I appreciate it.
[AGENT][POSITIVE] No problem at all. Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] Uh just a reference number if you can.
[AGENT][NEUTRAL] Yes ma'am, you can use my name. It's [PII]
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][POSITIVE] [PII] perfect thanks [PII]ain for your help.
[AGENT][POSITIVE] You're welcome. You have a good day and thanks for calling APL.
[CUSTOMER][POSITIVE] Thanks bye bye.
[AGENT][NEUTRAL] Bye bye.