AccountId: 011433970860
ContactId: 5d661ac8-2c7f-472a-a869-9e140faf78fd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 281899 ms
Total Talk Time (AGENT): 86627 ms
Total Talk Time (CUSTOMER): 132837 ms
Interruptions: 1
Overall Sentiment: AGENT=1.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/5d661ac8-2c7f-472a-a869-9e140faf78fd_20250210T14:32_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] Good morning, [PII]. My name is [PII]. I handle the health insurance for a company called TES, T E S S, and the manager of TAS is a guy named [PII]. His wife's name is [PII], and [PII] went to Holy Cross Hospital on [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I just hung up with the uh the people at Trinity Health which apparently handles the paperwork for Holy Cross, maybe they're part of that group, whatever.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And they said, uh, that Humana applied $10,090.58 to the deductible for.
[CUSTOMER][NEUTRAL] Uh, this claim and that APL then paid $447.23. So my question is why did APL not pay the $10,090.58?
[AGENT][POSITIVE] All right, [PII], it would be my pleasure to assist you. What is a good callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And do you have a Ms. Farmers policy number?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] I think this is her number at.
[CUSTOMER][NEUTRAL] At uh Humana, yeah, that's, I have a Humana number I see it right now.
[CUSTOMER][NEUTRAL] APL 16,690 is the group number.
[AGENT][NEUTRAL] Uh, do you see a card?
[CUSTOMER][NEUTRAL] No, I don't have a card.
[AGENT][NEUTRAL] OK, let me pull up the group.
[AGENT][NEUTRAL] And you are with the employer?
[CUSTOMER][NEUTRAL] I handle I'm the broker for with APL and I'm the broker for yeah.
[AGENT][POSITIVE] I got you.
[AGENT][POSITIVE] I got you now. Thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Just get my information pulled up, if you don't mind holding just one moment, Mr. [PII].
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Mm, don't mind at all.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's take a look at [PII]'s claims and see what's going on.
[AGENT][NEUTRAL] And you said that data service was.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Last year.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Got you.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Holy Cross Hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I see what happened. So, you know, their benefit on this policy is a benefit for outpatient. Their coverage is $500 per calendar day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Per day, OK.
[AGENT][NEUTRAL] Now we did receive a claim prior to receiving the facility claim.
[AGENT][NEUTRAL] And we paid 5277.
[CUSTOMER][NEUTRAL] And what, what was that data service or same data service but a different OK.
[AGENT][NEUTRAL] It's same day service, right, different provider.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We left that remaining amount for the facility.
[CUSTOMER][NEUTRAL] OK, OK, so, and, and it was done outpatient, so if that's why you paid it. OK, alright, that's what it is then $500 500 dollars, and uh, you have those two amounts up and it adds up to the $500.
[AGENT][POSITIVE] That's correct.
[AGENT][NEGATIVE] That's, that's basically it. I wish we could have paid more.
[CUSTOMER][POSITIVE] Yeah, right, yeah, alright, well I appreciate your help thank you so much.
[AGENT][POSITIVE] It's been my pleasure to assist you, Mr. [PII]. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Well, you can tell me who the what what is the Miami Hurricanes record gonna be this next season?
[AGENT][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] I love it.
[AGENT][NEUTRAL] Is that a good answer?
[CUSTOMER][POSITIVE] Under that's a good answer. Yeah, I, I, I, you'll live to go here. I'll talk to you later. Thank you. Bye-bye.
[AGENT][POSITIVE] All right, have a wonderful day bye bye.
[CUSTOMER][NEUTRAL] Hey