AccountId: 011433970860
ContactId: 6d57578a-155d-4a61-8f1f-73228aecb361
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 258500 ms
Total Talk Time (AGENT): 74736 ms
Total Talk Time (CUSTOMER): 117805 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/6d57578a-155d-4a61-8f1f-73228aecb361_20250523T15:48_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, hi, uh, [PII]. My name is [PII] calling from North Memorial Hospital. Um, I would like to review a denial claim with you.
[AGENT][NEUTRAL] OK, uh, Ms. She, I like to verify claim status for you. Uh, what's that policy number, please?
[CUSTOMER][NEUTRAL] D for Delta 462-056559.
[AGENT][NEUTRAL] Uh, it's not one of our policy numbers. Do you have the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Um, I have [PII].
[CUSTOMER][NEUTRAL] Um, [PII], that's the phone number they have listed here. Let me see if they have a card on file.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] No, we don't.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Were you able to find something?
[AGENT][NEUTRAL] Uh, what was that date of birth again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And Miss [PII], do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Thank you and what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] Um, data service [PII]. Um, total charge was, oh, let me go back.
[CUSTOMER][NEUTRAL] $3,521.18.
[AGENT][POSITIVE] OK, thank you, give me one moment.
[CUSTOMER][NEUTRAL] And then [PII], how do you spell it? Is it [PII]?
[AGENT][NEUTRAL] Uh [PII]
[AGENT][NEUTRAL] Last initial [PII] and you're calling from?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] North Memorial Health.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK. And it looks like on this claim, we paid $400.
[CUSTOMER][NEUTRAL] Yeah, so you guys pay $200. Is there any member responsibility?
[AGENT][NEUTRAL] Uh, we can't give patient responsibility. We can only verify how the claim was processed. Um, but I show on this one we paid $400. You're showing 200?
[CUSTOMER][NEUTRAL] No, we show $400 but the expected allow amount is $3,521.18 because we do not have a contract with you guys.
[AGENT][NEUTRAL] Well, with the patient's policies is uh limited medical indemnity plan.
[AGENT][NEUTRAL] So it's just a limited amount that's paid for like ER service, diagnostic, or surgery?
[CUSTOMER][NEUTRAL] Yeah, yeah, then let me see your EOB because the EOB did not spell out. Let me see if the balance is the patient responsibility. It's just like, yeah, we received the check but it did not say anything else other than that.
[AGENT][NEUTRAL] Well, our EOBs wouldn't state patient responsibility, uh, since we don't give patient responsibility.
[CUSTOMER][NEUTRAL] OK, then I, um, so you don't have, you don't give patient responsibility. I guess I have to give you this one with my manager because we have expected, uh, we have a set expected amount. If the patient has a limited contract, then usually the balance goes to the members, but you you know you you be did not state that I wanted to clarify that. OK, um, well, [PII], can I get a call reference number please?
[AGENT][NEUTRAL] I understand. Yes, ma'am.
[AGENT][NEUTRAL] Uh, if you like, you may use my name in today's date.
[CUSTOMER][POSITIVE] All right. Thank you very much, [PII]. You have a a nice long weekend.
[AGENT][POSITIVE] Uh, you too. Thank goodness. We need breaks around here. Yes, ma'am. Bye.
[CUSTOMER][POSITIVE] All right, thank you. All right. Yes, I agree. OK. All right, bye-bye.
[AGENT][NEUTRAL] Mhm