AccountId: 011433970860
ContactId: 58910b14-1620-4c29-80ad-cf192c186127
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 320690 ms
Total Talk Time (AGENT): 104714 ms
Total Talk Time (CUSTOMER): 141123 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/58910b14-1620-4c29-80ad-cf192c186127_20250612T17:36_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling for Progress West Healthcare, and I need some assistance with the claim.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] It's my direct line.
[AGENT][NEUTRAL] Thank you. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] 02221072
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [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 total bills for the claim?
[CUSTOMER][NEUTRAL] It was for [PII].
[CUSTOMER][NEUTRAL] Total bill charges $41,345.95.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the name of the provider on the claim, provider's office, I'm sorry.
[CUSTOMER][NEUTRAL] Progress West Healthcare.
[AGENT][NEUTRAL] OK, so I'm showing we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 361.
[AGENT][NEUTRAL] 0030.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim to the provider, a total of $1200.
[AGENT][NEUTRAL] And did you need any of the payment information?
[CUSTOMER][NEUTRAL] Well, we have the payment, but the EOB is only showing a payment. Uh, it doesn't show that.
[CUSTOMER][NEUTRAL] Uh, if there's a network used or if any patient responsibility doesn't show any of that. So is there any such an EOB that exists?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, um, so we're
[CUSTOMER][NEUTRAL] Doesn't show the total charges or any of that.
[AGENT][NEUTRAL] So, the explanation of benefits is not going to show like a patient responsibility or anything because we don't determine that since we're not a major medical. Um this is a hospital indemnity policy, so it is a limited medical benefit policy, um, but you said your explanation of benefits that you received doesn't show dollar amounts that were applied?
[CUSTOMER][NEUTRAL] Let me, let me tell you, I was gonna say let me share what I see, but you can't see what I see. Uh.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It's showing.
[CUSTOMER][NEUTRAL] Like it gives the check date, check number, policy number, paid to amount, patient information.
[CUSTOMER][NEUTRAL] The claim number and it says.
[CUSTOMER][NEUTRAL] The data service, our account number of the hospital and it says daily hospital benefits.
[CUSTOMER][NEUTRAL] For room and board $200.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then uh the next line says for annual first occurrence hospital.
[CUSTOMER][NEUTRAL] Uh, the remark is 1, and they pay, that was $1000 paid.
[CUSTOMER][NEUTRAL] And then the next, next page shows.
[CUSTOMER][NEUTRAL] Calendar year max for this benefit has been exhausted with the payment of this claim.
[CUSTOMER][NEUTRAL] So it says 1 PRP2E 0017.
[CUSTOMER][NEUTRAL] That's the remark code.
[CUSTOMER][NEUTRAL] But is there I don't see anything with the remark code with that remark code means.
[AGENT][NEGATIVE] Um, so on the 2nd, I don't know, is it front and back on the 2nd page is where the um definition for the remark is, it's just the calendar year max for the benefit has been exhausted, that's the remark code for that number 1 there.
[CUSTOMER][NEUTRAL] OK, so let me go back in here and see.
[CUSTOMER][NEUTRAL] OK. Well, I know that's the remark code, but it doesn't really, it is of course that you, that they exhausted the benefits, but
[CUSTOMER][NEUTRAL] Uh, so you're saying it's up to us if we want to build the number for the balance.
[AGENT][NEUTRAL] Right, we don't determine patient responsibility for any of our policies except dental.
[CUSTOMER][NEUTRAL] Is that what you said?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK. hm, that's different. OK, [PII], do we have a call reference number?
[AGENT][NEUTRAL] Um, no, ma'am. There's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you so much for all your time.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, that's all I have, thanks.
[AGENT][POSITIVE] Alright, thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm. Bye-bye.