AccountId: 011433970860
ContactId: 57567259-89b8-4c16-992d-1c3d9425e35d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 270899 ms
Total Talk Time (AGENT): 99655 ms
Total Talk Time (CUSTOMER): 64626 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/57567259-89b8-4c16-992d-1c3d9425e35d_20250218T16:10_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, this is [PII]. Last name initial [PII] [PII]. I need your help with one claim status.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the claim status and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes. Policy number is 01678802 M as in Mary, L as in Lima 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Name is [PII], [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] [PII]. Amount is $64,797.39.
[AGENT][NEUTRAL] Thank you for that and again, just for the call, the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][POSITIVE] Good Samaritan Medical Center.
[AGENT][NEUTRAL] OK, here it is.
[AGENT][NEUTRAL] So I'm showing we received the claim on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 352-633-5.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] And on [PII], the claim was denied because the inpatient benefit for the calendar year has been met.
[AGENT][NEUTRAL] And that max is $5000 per calendar year.
[CUSTOMER][NEUTRAL] OK. I think we did submit a corrected claim on this one on [PII], [PII]. Have you received that claim?
[CUSTOMER][NEGATIVE] Uh no
[AGENT][NEUTRAL] 1:30.
[AGENT][NEUTRAL] Hold on one second.
[AGENT][NEUTRAL] Um, no, that's, this is the only claim that was received for this data service.
[CUSTOMER][NEUTRAL] So, uh, the remaining or whatever we're expecting from APL is the responsibility of the patient as maximum already met.
[AGENT][NEUTRAL] Well, we don't determine patient responsibility because we're not a major medical insurance company, um, but yes, the inpatient benefit was exhausted by the time this claim was received, um, so that patient responsibility or determination would be up to the primary and the provider to determine.
[CUSTOMER][POSITIVE] OK. Uh, thank you so much for providing this information. May I have the reference number for the call?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. And again, my name is [PII] A. First initial to my last name is [PII], and then today's date.
[CUSTOMER][POSITIVE] Thank you so much and have a great day ahead.
[AGENT][POSITIVE] You also, and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.