AccountId: 011433970860
ContactId: 661e0978-b23e-45e5-8a99-109495ce4e88
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 314899 ms
Total Talk Time (AGENT): 95042 ms
Total Talk Time (CUSTOMER): 122544 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/661e0978-b23e-45e5-8a99-109495ce4e88_20250214T13:02_UTC.wav
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[AGENT][NEUTRAL] Calling UPL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi, ma'am. What did you say your name was?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Thank you. And my name is [PII] and I am calling from Erlanger Medical Hospital, ma'am. And I'm calling to check the status of a claim.
[AGENT][NEUTRAL] OK, I can help you, [PII]. What's the policy number?
[CUSTOMER][NEUTRAL] OK, let me pull it up.
[CUSTOMER][NEUTRAL] That is 01841277.
[AGENT][NEUTRAL] What's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] That is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII] and the birth date is [PII].
[AGENT][NEUTRAL] OK, and you said you're checking a claim status?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] And what's the data service?
[CUSTOMER][NEUTRAL] It's [PII] for $11,571.09.
[AGENT][NEUTRAL] And give me the total charge again, uh, [PII].
[CUSTOMER][NEUTRAL] OK, that was for 1 $11,571.09.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, verify the date of birth of the patient again.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That is [PII].
[AGENT][NEUTRAL] And for [PII], right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And so I show the claim was processed [PII], um, issuing a payment of $1,281.37.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] With this check, the maximum benefit payable for the date of service has been met, so this, this amount exhausted the outpatient benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][MIXED] OK, so the benefits have been met, has been met. It's exhausted.
[AGENT][NEUTRAL] Mhm. And I have the claim number if you would like that. Mhm.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Uh, that, uh, claim number is 35546553.
[AGENT][NEUTRAL] And any other questions I can help with today, [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am, we have a balance of 800 and.
[CUSTOMER][NEUTRAL] Let's see, I wrote it down somewhere.
[CUSTOMER][NEUTRAL] It's 800 and
[CUSTOMER][NEUTRAL] $6.17.
[CUSTOMER][NEUTRAL] So I don't understand why we have a balance. Is it because
[CUSTOMER][NEUTRAL] Like you said, the benefits have exhausted, so that's the
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] The benefits have been exhausted, so the maximum has been paid. So therefore, this $806.17 is that patient liability?
[AGENT][NEUTRAL] We do not determine patients responsibility.
[CUSTOMER][NEUTRAL] OK, but is it any discounts?
[CUSTOMER][NEUTRAL] Anywhere.
[AGENT][NEUTRAL] OK, so the, OK, so you'll look at your primary EOB.
[AGENT][NEUTRAL] And whatever that allowed amount is this policy will pick up generally that full amount, but this patient ran out of outpatient benefits. That's all that he had remaining so there's no discounts under this policy.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, outpatient.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] The discount will be under the major medical policy.
[AGENT][NEUTRAL] If any.
[CUSTOMER][NEUTRAL] OK, so what's, so what's left is um basically there is because the benefits has been exhausted.
[AGENT][NEUTRAL] We do not determine patients responsibility, [PII], that would be for the provider's office to determine based on the primary ELB.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, all right, ma'am, can um you give my reference numbers?
[AGENT][NEUTRAL] You'll use my name in today's date as your reference, [PII], first initial last name is [PII].
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] You're welcome thank you for calling APL have a good day.
[CUSTOMER][NEUTRAL] You too bye.