AccountId: 011433970860
ContactId: 5f78e03b-0d0d-44c7-88fa-077c1bda84aa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 238179 ms
Total Talk Time (AGENT): 120192 ms
Total Talk Time (CUSTOMER): 73157 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=2.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/5f78e03b-0d0d-44c7-88fa-077c1bda84aa_20250218T15:32_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. My name is [PII]. I'm calling from Jenny Stewart Medical Center. I have an EOB here from APL, and it tells me the payment amount, but I still have about $9000 unaccounted for, and I just didn't know if maybe I don't have the full EOB. I'm not sure if it's like a contractual or patient responsibility or anything.
[AGENT][NEUTRAL] OK, well, I'll be more than happy to help you with the claim, um, and the amount paid and the outstanding. Um, [PII], may I have a good contact number in case we're disconnected and then either the claim number or the policy number?
[CUSTOMER][NEUTRAL] Yes, uh, phone number is [PII] and the claim number is 3556561.
[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] Yes ma'am, name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment, and hold on one moment while I look at the claim.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] This is for data servers [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am, for $9,734.16.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, so it looks like 100 $150 was paid, $100 was paid towards the um
[AGENT][NEUTRAL] Diagnostic testing and then $50 was paid towards the emergency room.
[AGENT][NEUTRAL] Um, so in terms of the outstanding balance, so this is a hospital indemnity policy, so it's a limited medical policy. So there's like a list of covered services and then a dollar amount that will be paid towards that. So for diagnostic testing, um, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For diagnostic testing, the max is $100 for the initial um imaging.
[AGENT][NEUTRAL] If any follow-up imaging is needed, then it would be um $25 that would be paid towards the diagnostic testing. And then for the emergency room, the policy will pay up to $50 per visit with a max of 2 visits per calendar year.
[CUSTOMER][NEUTRAL] OK, thank you. And so is the rest of that, um, is that considered a non-covered charge then like the remaining balance since it's a limited uh policy?
[AGENT][NEUTRAL] So since it is a limited policy and we're not a major medical insurance company, we don't provide like patient responsibility or determinant. If there is an outstanding balance, that would just be um whatever your procedures are, write off bill, um, it would be up to the facility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect. Thank you for clarifying that um that is all that I needed. Are you able to provide a 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, my name is [PII] The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK, thank you so much for your help. I appreciate it.
[AGENT][POSITIVE] You're very welcome, [PII], and thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you, ma'am. You too.
[AGENT][POSITIVE] Thank you bye bye.
[CUSTOMER][NEUTRAL] OK, bye-bye.