AccountId: 011433970860
ContactId: 70602519-08de-4cfc-ab3e-7f41271cb5dc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 722260 ms
Total Talk Time (AGENT): 170301 ms
Total Talk Time (CUSTOMER): 93720 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=-2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/70602519-08de-4cfc-ab3e-7f41271cb5dc_20250430T13:52_UTC.wav
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[AGENT][NEUTRAL] Morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I am calling from [PII]. I have a claim that only um paid $50 and I'm just trying to confirm the patient's benefits and if you process in any network.
[AGENT][NEUTRAL] OK, sure, I can assist you with claims [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Uh yes, it is 02156805.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] We're staying there.
[AGENT][NEUTRAL] And do you have the claim number?
[CUSTOMER][NEUTRAL] Uh yes, claim number is.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] 352-847-4
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] That's also.
[AGENT][NEUTRAL] 352-8474.
[AGENT][NEUTRAL] OK, so this is an ER visit. OK.
[AGENT][NEUTRAL] Let me look at the benefits.
[AGENT][NEUTRAL] And this is not guarantee of payment, just a verification of coverage. OK, so for the, this is a limited hospital indemnity policy, um, for the ERV we do cover only $50 and that is an indemnity amount which is a flat amount.
[AGENT][NEUTRAL] Um, this one, let's see if the provider participates with multi plan they get that additional discount but it is not required.
[CUSTOMER][NEUTRAL] OK, so.
[AGENT][NEUTRAL] So there's no network.
[CUSTOMER][NEUTRAL] It does uh process through multi plan.
[AGENT][NEUTRAL] If the provider participates in the multi-plan, yes, um, I can check and see if it did, um, let me.
[AGENT][NEUTRAL] Let me go through the multi-plan side and see if this claim shows up. um, do you mind holding for me? I'll have to check on their side, OK?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yes, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me. I do apologize for that long wait. I had to find in the system. OK, so I do see where they repriced the, the claim.
[AGENT][NEUTRAL] Um, the total charge was 5,343 with 22, correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so the repriced amount based on multi-plan is $5,129.49.
[CUSTOMER][NEUTRAL] OK, are you gonna pay that?
[AGENT][NEUTRAL] No, that's the repriced amount. The benefit of the policy is just $50.
[CUSTOMER][NEUTRAL] around this theater
[CUSTOMER][NEUTRAL] OK, so this is process or multi plan which is the like in network rate.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And what is the patient responsible for?
[AGENT][NEUTRAL] Um, well, it's gonna be the difference between the $50 and the reprise amount which is, um, let me add this up one moment.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] $5,079.49.
[CUSTOMER][NEUTRAL] OK, I need an EOB that matches that amount that states patient responsibility because what we have does not show up.
[AGENT][NEUTRAL] We're not a major medical.
[AGENT][NEUTRAL] Mm. We're not a major medical, so we cannot send an you'll be like that. We're just a limited policy. We don't know if he has any other policies out there.
[AGENT][NEUTRAL] So that
[CUSTOMER][NEUTRAL] Yes, in order to build a patient though, we need an EOB that states those patient responsibility, especially if you process through a multi-plan network.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You can get that through multiplan. We, we only have access to their system to view the information, but um we don't have a way of sending this information over to you. We don't have a print out or anything that we can send out to the provider. Um, you should be able to go to multiplan and get a print out through multi plan so it will show you the repriced amount.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then with our EOB, the explanation of benefits indicate that is the maximum benefit. So, um, that is all we can send out because we're just a limited hospital indemnity plan. We're not a major medical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK, thank you, reference number?
[AGENT][NEUTRAL] You're welcome. Um, we don't have reference numbers. You can use my name in today's date. Do you need the spelling of my name or any other information?
[CUSTOMER][POSITIVE] No, that's it thank you.
[AGENT][POSITIVE] You're welcome and thank you for calling ATL.