AccountId: 011433970860
ContactId: 642ad26c-4c73-4d58-9cfb-89e087aec03c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 365279 ms
Total Talk Time (AGENT): 104227 ms
Total Talk Time (CUSTOMER): 128718 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/642ad26c-4c73-4d58-9cfb-89e087aec03c_20250521T16:14_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, good afternoon, [PII]. My name is [PII], and I was calling on behalf of the facility, and I was calling um about a claim that we received from you all. You did make a payment, um, but it didn't show if patient responsibility was left, and I also want to see if this claim was processed using a network.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, Ms. [PII], I can help you with your claims questions. May I please get your callback number, ma'am, just in case our call is disconnected.
[CUSTOMER][NEUTRAL] Yes, it's [PII], and that's that right?
[AGENT][NEUTRAL] Thank you and what's the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Piedmont Augusta Hospital.
[AGENT][NEUTRAL] OK, and may I get the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] OK, um, the first name is [PII] Last name is [PII] Date of birth [PII]. Policy number 2586493.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Let me pull up that policy real quick.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and then what is uh the data service and the charge amount?
[CUSTOMER][NEUTRAL] OK, this is for data service [PII].
[AGENT][NEUTRAL] OK, and what was the charge amount please?
[CUSTOMER][NEUTRAL] This 1 $84,07.48.
[AGENT][NEUTRAL] Thank you and then what is um the claim number that you have?
[CUSTOMER][NEUTRAL] All right, this is for claim number. Let me pull it back up over here.
[CUSTOMER][NEUTRAL] 3,561,840
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold, Miss [PII], while I look this claim up and I'll be right back, ma'am.
[CUSTOMER][POSITIVE] OK, thanks.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, thank you for holding for me. I've got the claim information pulled up now.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] I do see that the claim was paid. We do not give patient responsibility that's determined by the provider.
[AGENT][NEUTRAL] And the network for this plan is through multiplan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Cause yes, on the EOB that we received from you all.
[AGENT][NEUTRAL] And so the, the benefits were based on the policy certificate.
[CUSTOMER][NEUTRAL] OK, yeah, because it shows here on the EOB ce say max benefit um reached.
[CUSTOMER][NEUTRAL] Um, and so we did receive your payment, but it still shows the outstanding balance of $36,003.37. So you don't show if that will go to the patients if their benefits have been met already.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right, so the, the, um, the remark on the EOB that the benefit maximum was met is based on the policy contract with the insured on the plan, so that was the maximum benefit payable.
[AGENT][NEUTRAL] For this claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's a limited hospital indemnity plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. So it'll be up to the provider if you wanna.
[CUSTOMER][NEUTRAL] Send that to the patient.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Got it. OK. Um, I believe that is all the information I needed. And can I have your name again and a reference number?
[AGENT][NEUTRAL] Yes, my name is [PII], it's [PII] and you can use my name and today's date as your reference.
[CUSTOMER][POSITIVE] All right. Thank you so much, [PII]. I hope you have a wonderful day.
[AGENT][POSITIVE] You too, Miss [PII], thank you for calling APL.
[AGENT][POSITIVE] You have a good day also.
[CUSTOMER][POSITIVE] You're welcome bye bye.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye bye.