AccountId: 011433970860
ContactId: 88212727-f6ce-4cff-a5b6-42162b6235b3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 313959 ms
Total Talk Time (AGENT): 114283 ms
Total Talk Time (CUSTOMER): 126569 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/88212727-f6ce-4cff-a5b6-42162b6235b3_20250502T18:47_UTC.wav
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[AGENT][POSITIVE] Good morning or good afternoon. Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good day, [PII]. My name is [PII] and I'm calling from VHS Brownsville Hospital, and we received your correspondence from our.
[CUSTOMER][NEUTRAL] From our written appeal and I just have a specific question regarding this response.
[AGENT][NEUTRAL] OK. OK, give me one minute.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And do you have the policy certificate number of the insured?
[AGENT][NEUTRAL] Or the certificate number?
[CUSTOMER][NEUTRAL] Yes, um,
[CUSTOMER][NEUTRAL] I think that's the ID number. OK, before I proceed, I just want to let you know that this call may be monitored or recorded for quality assurance. Uh, certification number is 02243512.
[AGENT][NEUTRAL] And what's the name of the insured?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And what is her date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and thank you. And I'm sorry, what is your name again?
[CUSTOMER][NEUTRAL] [PII], spelled as [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, [PII]. OK, thank you, [PII]. And what is a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] That's [PII], no extension number.
[AGENT][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] [PII]. Is that correct?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Yes, that's correct, yes.
[AGENT][NEUTRAL] [PII]. OK. Thank you, [PII]. And what is the provider's office that you're calling with?
[CUSTOMER][NEUTRAL] Yes, I'm calling from DHS Brownsville Hospital.
[AGENT][NEUTRAL] OK, thank you, [PII]. And what, um, do you have a claim number by any chance?
[CUSTOMER][NEUTRAL] Yes, I do have the claim number is 3373473.
[AGENT][NEUTRAL] OK, thank you, [PII]. Give me one minute and let me get this information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said that you have a um
[AGENT][NEUTRAL] Uh, you have a question regarding the letter that I had sent you?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and how may I help you?
[CUSTOMER][NEUTRAL] Yes, cause it states here that the member's schedule of benefit is 2550.
[CUSTOMER][NEUTRAL] Dollars per covered person per calendar year and you paid.
[CUSTOMER][NEUTRAL] Oh [PII]
[CUSTOMER][NEUTRAL] $2540 even.
[CUSTOMER][NEUTRAL] I'm calling to verify if the remaining amount that the primary insurance allowed can be billed to the patient.
[AGENT][NEUTRAL] Uh, yes, um, because we're not a major medical, we're just a supplemental policy, so any remaining, uh, balance would be the, um, insurance responsibility. We have no network and no contract, so we just do not, since we're a hospital indemnity, we do not put that into our EOBs of, you know, what the remaining balance is. That is up to the provider as to tell them what the remaining balance is for them what is required for them to pay back.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So any access from the patient's benefit can be billed to them.
[AGENT][NEUTRAL] Yes, it is their responsibility.
[CUSTOMER][POSITIVE] OK, thank you so much, [PII].
[CUSTOMER][NEUTRAL] I think that covers all the information I need because we already received your correspondence and the appeal is already exhausted but it.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All the information is already here so I'm just, I'll just go ahead and build the remaining amount to the patient. Um, can I just have the call reference number please?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, we don't use call reference number. You can just use my name and today's date.
[CUSTOMER][POSITIVE] OK, [PII], thank you so much and you do have a great day.
[AGENT][NEUTRAL] Right
[AGENT][POSITIVE] Uh, thank you. Is there anything else I can help you out with, my, my home?
[CUSTOMER][NEUTRAL] Bye.
[AGENT][POSITIVE] Mm, OK, well, you're welcome. Thank you for calling American Public Life. Have a great day.
[CUSTOMER][POSITIVE] No, that will be all. Thank you so much for asking.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah