AccountId: 011433970860
ContactId: 5d1e0729-cdad-4479-b95d-c934b769fa06
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 378459 ms
Total Talk Time (AGENT): 178486 ms
Total Talk Time (CUSTOMER): 120420 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/5d1e0729-cdad-4479-b95d-c934b769fa06_20250410T13:07_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] Uh, yes, my name is [PII] with Cook Children's Physics Network, and I need to check claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the claim status and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] and that's a direct line.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Um, it's 02592877.
[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] Um, uh, [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] It's 37 2025 $259.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] So I'm sure to received the claim on [PII].
[AGENT][NEUTRAL] That claim number is 358.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 3552.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim a total of $50 to the provider.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you need that check information?
[CUSTOMER][NEUTRAL] Uh, no, I got the $50 but, uh, that's all you're gonna pay?
[AGENT][NEUTRAL] Yes, for that benefit, um, hold on one moment, it's coming up now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the benefit for physician's office is $50 per visit with a max of 4 visits per calendar year for the hospital indemnity policy.
[CUSTOMER][NEUTRAL] So, the patient is responsible for anything?
[AGENT][NEUTRAL] Well, we don't determine patient responsibility because we're not a major medical, so it would be whatever the policy is for remaining outstanding balances after.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Our portion from the policy is paid.
[CUSTOMER][NEUTRAL] OK, so, OK, so basically, you pay 50 and the balance is the member's responsibility, right?
[AGENT][NEUTRAL] We don't determine patient responsibility. So that's why it's not on the explanation of benefits.
[CUSTOMER][NEUTRAL] So who determined that?
[AGENT][NEUTRAL] You as the provider.
[CUSTOMER][NEUTRAL] OK, but I need to know who, who, who's who's gonna pay the 209.
[AGENT][NEUTRAL] That's up to you as the provider. Do you write it off, do you bill the patient? We just can't determine that because we're not major medical.
[CUSTOMER][NEUTRAL] Yeah, we don't determine that, ma'am, because you guys are the ones that need to tell us what do we need with the balance.
[AGENT][NEUTRAL] Well, that's why it's not on the explanation of benefits. Legally we can't do that, um, but if you like, I can um get a claims examiner on the line to go over this further with you.
[CUSTOMER][POSITIVE] Yes, thank you. Mhm.
[AGENT][POSITIVE] You're welcome. Before I do that, was there anything else I could assist you with today?
[CUSTOMER][POSITIVE] No, ma'am. Thank you.
[AGENT][NEUTRAL] Alright, you're welcome. Hold on one moment and thanks for calling APL.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Deferring
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Good morning. Thank you for calling APL. This is [PII] speaking. How can I help you?
[AGENT][NEUTRAL] Hey, [PII], this is [PII] on the care team. How are you doing?
[CUSTOMER][POSITIVE] Doing well [PII] thank you how are you?
[AGENT][POSITIVE] I'm doing good. I have a provider on the other line that wants to speak to someone. Um, we did a claim status, she
[AGENT][NEUTRAL] wants to know patient responsibility. I told her we don't determine that. That's why it's not on the explanation of benefits. We're not major medical, blah blah blah, and she's like, well, you, you have to tell me something because it has to come from you. So, um, do you need the policy number?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Alright, it's 259287-7.
[CUSTOMER][NEUTRAL] OK, just give me one second, and the patient's been verified?
[AGENT][NEUTRAL] OK, and it's part 3.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And what's their name please?
[AGENT][NEUTRAL] Her name is [PII], who we're speaking with.
[CUSTOMER][NEUTRAL] [PII], and is that a good call back number on the screen or did she give you a different number?
[AGENT][NEUTRAL] Oh, it says claim support now, but I have um [PII]. Is that what you see?
[CUSTOMER][NEUTRAL] No, I have a [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] Oh no.
[CUSTOMER][NEUTRAL] So 303 OK 1848 682 now.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And it's [PII] and it's for Victoria, is that correct?
[AGENT][NEUTRAL] Yes, and is that
[CUSTOMER][NEUTRAL] Uh, participant 3.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it's that last claim, well, the last process claim, the 3583552.
[CUSTOMER][NEUTRAL] OK, I'll pull that up right now and you can go ahead and put her through when you're ready.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Oh, actually, it looks like she hung up. Never mind.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Uh oh
[AGENT][NEUTRAL] Well, I
[CUSTOMER][NEUTRAL] I can call her back. I can try.
[AGENT][NEGATIVE] OK, I don't, she just, I don't think she understands the patient responsibility part.
[CUSTOMER][NEUTRAL] If, if need be.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] I will try to give her a ring back. I get her, I get her. You said it was [PII], right?
[AGENT][NEUTRAL] [PII] yes, the phone number. Mhm. I'm like, what number is that? Yes.
[CUSTOMER][NEUTRAL] Yep, sorry.
[CUSTOMER][NEUTRAL] What? No, it's early, huh? All right.
[AGENT][POSITIVE] It is, but it's OK because I need to laugh, so thank you very much.
[CUSTOMER][POSITIVE] Yeah, you're welcome have a great day.
[AGENT][POSITIVE] Alright, have a good day.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][POSITIVE] Thanks you too bye.