AccountId: 011433970860
ContactId: 7252babf-3c08-4f48-81d5-2d4ca9bd3365
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 724409 ms
Total Talk Time (AGENT): 192545 ms
Total Talk Time (CUSTOMER): 197870 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/7252babf-3c08-4f48-81d5-2d4ca9bd3365_20250613T14:07_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from Holy Name Medical Center to check up on claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, [PII]. And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that, and [PII], how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Only one time I'm.
[AGENT][NEUTRAL] Alright, may I have the member's policy number?
[CUSTOMER][NEUTRAL] Policy number is 245328185.
[AGENT][NEUTRAL] I'm sorry, 245328185?
[CUSTOMER][POSITIVE] Yeah, that's right.
[AGENT][NEUTRAL] Um, OK, let me try that. Is that their primary or is that their APL? That's, that's too many numbers for APL.
[AGENT][NEUTRAL] Unless, is that a social?
[CUSTOMER][NEUTRAL] Oh. So just a moment OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] The policy number is 02453281.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] And can you verify the member's first and last name and date of birth? Patient name here is [PII], and date of birth is on [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. May I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Thank you for the information. There are services in the date range of [PII].
[CUSTOMER][NEUTRAL] For the amount of $18,830.25.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Can you verify the name of the
[CUSTOMER][NEUTRAL] Yeah, Holy Name Medical Center.
[AGENT][NEUTRAL] Alright, so the claim was received on [PII]?
[CUSTOMER][NEUTRAL] Alright
[AGENT][NEUTRAL] The claim number is 3502242.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] the number is 350
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], we paid out.
[CUSTOMER][NEUTRAL] Can I get decline?
[AGENT][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] On [PII] it got paid, right?
[AGENT][NEUTRAL] No, [PII].
[CUSTOMER][NEUTRAL] Yeah, can I get the claimed amount?
[AGENT][NEUTRAL] Um, hold on one moment.
[AGENT][NEUTRAL] Did you need to know the decision of the of the claim or just the allowed amount?
[CUSTOMER][NEUTRAL] Did you need to know the decision of the of the claim or just the allowed amount?
[CUSTOMER][NEUTRAL] I allow the amount and the.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Decision as well.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Hold on one moment
[AGENT][NEUTRAL] So this is a hospital indemnity policy. The benefits used was the hospital admission benefit.
[CUSTOMER][POSITIVE] The hospital and patient benefits.
[AGENT][NEUTRAL] Which is $2500 per calendar, I'm sorry, per calendar year.
[CUSTOMER][NEUTRAL] Which is 25.
[AGENT][NEUTRAL] For one day
[AGENT][NEUTRAL] And then the daily hospital benefit was used?
[AGENT][NEUTRAL] And let me see what that is.
[AGENT][NEUTRAL] Up to $100 per day per calendar year with a max of 15 days.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yeah, can I get the allowed amount?
[AGENT][NEUTRAL] That's what I just provided to you. Did you need me to repeat it?
[CUSTOMER][NEUTRAL] That's what I just provided to you.
[CUSTOMER][NEUTRAL] Yes, can you repeat it slowly?
[AGENT][NEUTRAL] The hospital admission benefit is up to 2500.
[CUSTOMER][NEUTRAL] The hospital admission benefit is up to 2500.
[AGENT][NEUTRAL] One day per calendar year.
[CUSTOMER][NEUTRAL] One day per.
[AGENT][NEUTRAL] The daily hospital benefit is up to $50.
[CUSTOMER][NEUTRAL] One day per calendar we are right.
[AGENT][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] Sorry for the interrupting.
[CUSTOMER][NEUTRAL] So studying the hospital benefit is for $2500.01 day per calendar year, right?
[AGENT][NEUTRAL] Up to $2500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Sorry for that.
[CUSTOMER][NEUTRAL] Yeah, go with that.
[AGENT][NEUTRAL] The daily hospital benefit is up to $100 per day, 15 days per calendar year.
[CUSTOMER][NEUTRAL] Sorry, could you repeat that slowly? I could talk about it.
[AGENT][NEUTRAL] $100 per day.
[AGENT][NEUTRAL] 15 days per calendar year.
[CUSTOMER][NEUTRAL] So we have uh you have paid only $1700. What about the remaining?
[AGENT][NEUTRAL] Um, we don't determine patient responsibility, so any remaining balances would be up to you as the provider.
[CUSTOMER][NEUTRAL] Um, we don't determine patient responsibility, so any remaining balances would be up to you as a provider.
[CUSTOMER][NEUTRAL] So there is no patient responsibility, right?
[AGENT][NEUTRAL] We don't determine patient responsibility.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yes, can you hear me?
[CUSTOMER][NEUTRAL] Yes I can hear you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It is up to provider, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So I'm just asking you on the.
[CUSTOMER][NEUTRAL] On this claim you have $8700 right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And, uh, you said that, uh, the hospital benefit is up to $2500.01 day per calendar is.
[CUSTOMER][NEUTRAL] So still we have nearly $800 remaining.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Uh, so why it is not covered?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Because the $2500 is for the entire year. All they had left of that balance was the $1500 that was applied.
[CUSTOMER][NEUTRAL] So for the
[CUSTOMER][NEUTRAL] Calendar year.
[CUSTOMER][NEUTRAL] Leftover of 1500 has been processed and paid.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Oh, what is about uh $200 has been paid.
[CUSTOMER][NEUTRAL] On this claim
[AGENT][NEUTRAL] For 2 days, [PII], it's $100 per day, so that's $200.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] And [PII], was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] And was there anything else I can
[CUSTOMER][NEUTRAL] Can I get the call reference number?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date.
[AGENT][NEUTRAL] The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] they
[CUSTOMER][NEGATIVE] Yeah, no
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, and I do have another one more clarification on this one. Just a moment of you.
[CUSTOMER][NEUTRAL] So the remaining charges has been processed as benefits accessed, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, the remaining balance.
[CUSTOMER][NEUTRAL] No, the remaining balance.
[AGENT][NEUTRAL] We didn't, we didn't discuss anything with the, with the remaining balance because we don't determine the responsibility. So if there is one, that would be up to you as a provider to determine.
[CUSTOMER][POSITIVE] Thank you for asking me today. Have a nice day. Bye bye.
[AGENT][NEUTRAL] Was there anything else I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] No, that's all for today's call. Have a nice day. Bye bye for now. Have a great weekend.
[AGENT][POSITIVE] Alright, thanks for calling APL.
[AGENT][NEUTRAL] Bye bye.