AccountId: 011433970860
ContactId: 7eb1750b-778b-4d8a-b4b9-a96a937ab5ab
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 559419 ms
Total Talk Time (AGENT): 166952 ms
Total Talk Time (CUSTOMER): 152212 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/7eb1750b-778b-4d8a-b4b9-a96a937ab5ab_20250116T15:12_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. I have 3 claims for the same patient that I'm looking for claim status on.
[AGENT][NEUTRAL] OK, what's your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And [PII], what's the policy number?
[CUSTOMER][NEUTRAL] It is 211-067-3.
[AGENT][NEUTRAL] OK. Give me one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Thank you, [PII], for holding. I have that file pulled up. Can you verify the patient's name and date of birth for me?
[CUSTOMER][NEUTRAL] Is [PII].
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK, and you said that you're checking claim status for [PII]?
[CUSTOMER][NEUTRAL] Yes, I have 3 of them.
[AGENT][NEUTRAL] OK, what's a good call back number for you?
[CUSTOMER][NEUTRAL] It's [PII] and that's a direct line.
[AGENT][NEUTRAL] And thank you. What's the date of service and total charge?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] The first one is for [PII].
[CUSTOMER][NEUTRAL] For $490.
[AGENT][NEUTRAL] OK. So do you have different claims for different patients or all the same patients, for the same patients? Go ahead and give me all of them.
[CUSTOMER][NEUTRAL] All the same, yeah.
[CUSTOMER][NEUTRAL] OK, then, uh, [PII].
[CUSTOMER][NEUTRAL] For the same amount $490 they're they're all $490.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then the last date is [PII] for foreign range.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so under this policy, um, outpatient hospital services are not covered, and so the A10 data service and if they're all for the same thing or they all the same thing.
[CUSTOMER][NEUTRAL] Yes, it's an office visit.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So it's just pretty much hospital.
[AGENT][NEUTRAL] So was it done in a hospital setting or an office setting?
[CUSTOMER][NEUTRAL] Oh no, I'm, it was office. I'm, I was just asking you if um they're only covered for hospital.
[AGENT][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] OK, is this a limited benefit plan?
[AGENT][NEUTRAL] It is a limited hospital indemnity policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] You'll be fine.
[AGENT][NEUTRAL] Was this claim billed on a hospital, a UBL4 or CMS 1500 form?
[CUSTOMER][NEUTRAL] Uh, let's look, I think it's the 1500.
[AGENT][NEUTRAL] Is it
[CUSTOMER][NEUTRAL] Yeah, 1500.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] You're talking about the claim, right?
[AGENT][NEUTRAL] Mhm. Yes.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] OK, the place of service on the claim is 22, which is outpatient.
[AGENT][NEUTRAL] And outpatient hospital is not covered under this policy. Did you need the claim numbers for each date?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Um, that would be good too. Would you be able to fax me those ELBs so I could build a patient?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] They were actually mailed when the claims were processed to the address that's on the the billing address on the claim and so they're available to download on our from our online service center I can give you that web address if you would like.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Yes please I love websites.
[AGENT][POSITIVE] OK. It's [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The word [PII], so [PII].
[CUSTOMER][NEUTRAL] OK, then I could probably get the uh claim numbers and stuff off of there too, right?
[AGENT][NEUTRAL] Well there's a quick access or quick search and you'll need the claim number so let me give you the claim number for each of the dates. So for the August date, uh huh, the claim number is 335-0612.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] OK great.
[AGENT][NEUTRAL] And then for the July date of service, the claim number is 334.
[AGENT][NEUTRAL] 0148.
[AGENT][NEUTRAL] And for the September date of service, the claim number is 3361796.
[CUSTOMER][NEUTRAL] 1796.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] I wrote a night for some reason. I knew it wasn't right, but my mind and hand is not working together today, so.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, do you have a uh reference number for me?
[AGENT][NEUTRAL] You'll use my name in today's date as your reference, [PII]
[AGENT][NEUTRAL] And first initial of my last name?
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] Oh, the first initial of my last name is [PII].
[CUSTOMER][NEUTRAL] Your first.
[CUSTOMER][NEUTRAL] OK, [PII], um.
[CUSTOMER][NEUTRAL] By chance your website isn't hard to get at and you explain to people how to get on there, is it?
[CUSTOMER][NEUTRAL] How to use it.
[AGENT][NEUTRAL] And are you there?
[CUSTOMER][NEUTRAL] No, I, I just thought I talked to you like last week or something and you had showed me to get how to get on there because it was difficult, but it must not be you, so I do a lot of websites so OK, OK.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Yeah, ours is very simplistic when you get to the site.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, the home page is gonna say online service center welcome.
[AGENT][NEUTRAL] And if you have not created an account to the right, there's two tabs. One says log in that's only if you have an active account and then new users as if you don't.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, all right, I just thought maybe you are who I talked to and she had explained it was their site was really hard and definitely needed it wasn't easy use, so that's why she did she offered it, yeah.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] Yeah, this is very, very user friendly. OK, yeah.
[CUSTOMER][POSITIVE] OK, then I can get it. All right, thank you so much [PII], and you have a good day.
[AGENT][POSITIVE] Oh, you're welcome, [PII]. If no other questions, thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Uh-huh. Bye-bye.