AccountId: 011433970860
ContactId: 5b065fdf-09a0-4a2d-97b6-80084972b83f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 386809 ms
Total Talk Time (AGENT): 165846 ms
Total Talk Time (CUSTOMER): 114179 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/5b065fdf-09a0-4a2d-97b6-80084972b83f_20250609T18:38_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 from Hartford Healthcare. I'm not quite sure I pressed the right prompt. I'm not sure what type of plan this patient has. Um, so I'm hoping you can help me with some claim statuses today.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the claim status, and it's one member multiple claims or multiple members in multiple claims?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 1 member, 3 claims.
[AGENT][NEUTRAL] OK, and [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yes, good contact number, um, direct line, no extension is [PII].
[AGENT][POSITIVE] Thank you. And the policy number? Oh, I'm sorry.
[CUSTOMER][NEUTRAL] And I.
[CUSTOMER][NEUTRAL] Yes, no worries. Um, policy number is 02518439.
[AGENT][NEUTRAL] OK, 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 the total bill for the claim?
[CUSTOMER][NEUTRAL] Yes, um, the first one is [PII]. Billed amount $759 even.
[AGENT][NEUTRAL] OK, you can give the other two if you like.
[CUSTOMER][NEUTRAL] OK. Um, the second one is [PII].
[CUSTOMER][NEUTRAL] Billed amount $449 even.
[CUSTOMER][NEUTRAL] And the last one is [PII].
[CUSTOMER][NEUTRAL] And the billed amount is $449 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, so I'm just waiting for them to come up now hold on one moment.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Kind of love technology.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, here we go. So the first one,
[AGENT][NEUTRAL] Data Service 8-19-2024. We received that claim on [PII].
[AGENT][NEUTRAL] The claim number is 352.
[AGENT][NEUTRAL] 713 2.
[AGENT][NEUTRAL] Oh, you know what I'll do?
[AGENT][NEUTRAL] I'll give you the date received process and the claim number for all of them and then the denied reason because they're all denied for the same reason. Does that work for you?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That works perfectly.
[AGENT][NEUTRAL] And then the second one is [PII]. It's uh well, hold on.
[AGENT][NEUTRAL] Sorry.
[AGENT][NEUTRAL] OK, the first one and the second, these last two, they're gonna have the same, so they're both [PII] was received.
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][NEUTRAL] The, oh, they're both the same amount. Um.
[AGENT][NEUTRAL] So for [PII], that claim number is 3531906.
[AGENT][NEUTRAL] [PII] is 3, I'm sorry, 3531904.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And they were both processed on [PII]?
[AGENT][NEUTRAL] And all three claims were denied, um.
[AGENT][NEUTRAL] Because the outpatient rider only allows payment for outpatient surgery in an outpatient hospital or physician office, therefore, no, no benefits are payable.
[CUSTOMER][NEUTRAL] OK. Is there any way that I can get a copy of those EOBs, either faxed or emailed?
[AGENT][NEUTRAL] Yes, what's a good fax number for you?
[CUSTOMER][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] That's [PII]. Should I put attention, [PII]?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Alright, so I'll go ahead and fax these 3 over to you now. Was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Yes, it's really quick, um, does that mean that the full balance is the patient responsibility or is there a certain allowed amount?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So we don't determine patient responsibility.
[CUSTOMER][NEUTRAL] Or no
[AGENT][NEUTRAL] Um, because we're not the major medical, but since nothing was applied, it will be the full balance. It's just, uh, we just can't advise if you bill it or write it off, that's up to the provider.
[CUSTOMER][NEUTRAL] Understand completely. Now, this patient has a secondary, um, secondary policy, so that's what I was um.
[CUSTOMER][POSITIVE] I was just asking for that reason, but thank you so much.
[AGENT][POSITIVE] You're very welcome. Well, was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] May I have a call reference number please?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. And again, that's [PII], first initial of my last name is [PII].
[CUSTOMER][POSITIVE] Perfect. Thank you so much for your help.
[AGENT][POSITIVE] You're welcome, [PII] and thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] You as well thank you.
[AGENT][POSITIVE] Thank you. You're welcome. Bye-bye.