AccountId: 011433970860
ContactId: 86e379fd-1d23-4c90-8b35-ea7c334bd7b8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 262820 ms
Total Talk Time (AGENT): 112100 ms
Total Talk Time (CUSTOMER): 69239 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/86e379fd-1d23-4c90-8b35-ea7c334bd7b8_20250401T20:23_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, it's [PII] calling from Pomona Valley Medical Center. Can I check for claim status, please?
[AGENT][POSITIVE] Yes, I'll be more than happy to help you with the claim status, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] direct.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] 2506865
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim?
[CUSTOMER][NEUTRAL] I have.
[CUSTOMER][NEUTRAL] [PII] $72,187.40.
[AGENT][NEUTRAL] Alright, thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the name of the um facility on the claim?
[CUSTOMER][NEUTRAL] Amona Valley Medical Center.
[AGENT][NEUTRAL] Alright, I'm showing the claim was received on [PII].
[AGENT][NEUTRAL] Claim number 358.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 1513.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim.
[AGENT][NEUTRAL] A total of $1000.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Did you need the check information?
[CUSTOMER][NEUTRAL] Do you have a payment information?
[CUSTOMER][NEUTRAL] I do.
[AGENT][NEUTRAL] OK, hold on one second.
[AGENT][NEUTRAL] So that was a single check, um, check number 2035606.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was mailed to [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it was issued on [PII].
[CUSTOMER][NEUTRAL] Do you have the ZIP code [PII]?
[AGENT][NEUTRAL] Hold on one moment. Zip code is [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Great. Now, what is the patient portion on this one then?
[AGENT][NEUTRAL] We don't determine patient responsibility because we're not the major, a major medical insurance company.
[CUSTOMER][NEUTRAL] Are you the supplemental policy to Aetna or you, what kind of policy is this?
[AGENT][NEUTRAL] So, yes, this is a secondary insurance. We apply to the co-pay, deductible and co-insurance after Aetna.
[CUSTOMER][NEUTRAL] But after Aetna paid, there was a patient responsible $2,761.80. You don't pay.
[CUSTOMER][NEUTRAL] The rest
[CUSTOMER][NEUTRAL] Like whatever the remaining that primary pay, Aetna pay?
[AGENT][NEUTRAL] No, so, so their secondary insurance has benefits also. Let me see what the max was. Um, so for inpatient, the max is $1000 per occurrence, for outpatient it's $500 per occurrence. So that max of $1000 was paid towards this claim.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, that's all I need to verify. Thank you, [PII]. I'll call this number, [PII].
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date, and the first initials of my last name is [PII].
[CUSTOMER][POSITIVE] Got it. Thank you.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today, [PII]?
[CUSTOMER][POSITIVE] No, that's it. Thank you.
[AGENT][POSITIVE] Alright, thanks for calling APL. Have a great day. Bye-bye.
[CUSTOMER][POSITIVE] Thank you bye.