AccountId: 011433970860
ContactId: 6a0793b2-7c61-4a55-9520-27f58d1bb385
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 494570 ms
Total Talk Time (AGENT): 108250 ms
Total Talk Time (CUSTOMER): 92827 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/2025/03/05/6a0793b2-7c61-4a55-9520-27f58d1bb385_20250305T21:06_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, my name is [PII] with Earling Medical Center, and I was calling on a claim.
[AGENT][NEUTRAL] OK, I can help. It's [PII].
[CUSTOMER][NEUTRAL] Did you say your name?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the policy number, [PII]. You're welcome.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] 023 06089
[AGENT][NEUTRAL] And what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Area code [PII], that's my direct line.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], date birth [PII].
[AGENT][NEUTRAL] All right, thanks for that information, [PII]. And you said that you're checking claim status, right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm. Provide the date of service and the total charge, please.
[CUSTOMER][NEUTRAL] Data service [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Total charge $329,480.96.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] Still looking.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And so, what's the name of the hospital?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Burlingga Medical Center.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Showing the benefit maximum for this state of service is met. Give me a second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it looks like we also received the claim from the.
[AGENT][NEUTRAL] Policyholder prior to your claim and pay and paid out on that claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's why yours was stating that the benefit max for this hospital stay is maxed.
[AGENT][NEUTRAL] Now, I'll give you.
[AGENT][NEUTRAL] The claim number that I have for your claim?
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Um, I'm showing.
[AGENT][NEUTRAL] 354.
[AGENT][NEUTRAL] 9248.
[AGENT][NEUTRAL] And that claim processed on [PII].
[AGENT][NEUTRAL] 2025.
[CUSTOMER][NEUTRAL] Mhm. And y'all play the patient?
[AGENT][NEUTRAL] It looks like the policyholder submitted the claim as well.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let me say that I request the claim.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] I wonder how they got the claim. Let me see. That's why we see did they call and request the claim.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Did they send an itemized to you all or the claim?
[AGENT][NEUTRAL] You know, we can't disclose any information about what they sent. Uh, you'll need to communicate with the patient though if you have further questions.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK, and how much did y'all pay out to the patient?
[AGENT][NEUTRAL] We can't disclose that information because it, it was submitted by the, by the insured.
[CUSTOMER][NEGATIVE] Oh, so you can't even tell me so I can bill them for it.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No, you'll have to reach out to the patient.
[CUSTOMER][NEUTRAL] OK, uh.
[CUSTOMER][NEUTRAL] I guess ain't nothing else I can do then.
[CUSTOMER][NEGATIVE] I don't they don't respond and billing the whole total charge of $329,480.96.
[AGENT][POSITIVE] That's funny.
[CUSTOMER][NEUTRAL] That is crazy. They beat it. What kind of plan is this for them to uh for you all to?
[AGENT][NEUTRAL] This is a, it, it's, it's a limited hospital indemnity plan.
[CUSTOMER][NEUTRAL] Oh, no wonder.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So yeah, yeah. Hey the patient.
[CUSTOMER][NEUTRAL] OK, uh, can I have a reference number for this call then?
[AGENT][NEUTRAL] Sure, you can use my, you'll use my name in today's state as your reference, uh, [PII].
[AGENT][NEUTRAL] ONYA and then first initial of my last name is [PII]. And did you have any other questions that I could help with today?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] That'll be it.
[AGENT][POSITIVE] OK, well thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Uh bye bye.