AccountId: 011433970860
ContactId: 8aedb040-bead-4881-ad1b-c9f57f5b787e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 381239 ms
Total Talk Time (AGENT): 132950 ms
Total Talk Time (CUSTOMER): 129209 ms
Interruptions: 3
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/8aedb040-bead-4881-ad1b-c9f57f5b787e_20250212T16:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I need claim status.
[AGENT][NEUTRAL] OK, I could check on a claim for you. What was your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, uh, [PII], are you with a provider or is this for your individual policy?
[CUSTOMER][NEUTRAL] Provider
[AGENT][NEUTRAL] OK, uh, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] It is 02445118.
[AGENT][NEUTRAL] Alright, thank you. What was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] Come on computer. Uh [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, thank you for verifying that [PII]. What was the date of service for this claim?
[CUSTOMER][NEUTRAL] It's [PII] would be a 30,48552.
[AGENT][POSITIVE] OK, thank you one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Was this for is that uh Broward Health?
[CUSTOMER][NEUTRAL] No, Bro have North.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so we did receive this claim, [PII] looks like we were unable to pay a benefit as the maximum for the date of service had already been met.
[CUSTOMER][NEUTRAL] Huh?
[AGENT][NEGATIVE] We were unable to pay a benefit as the maximum benefit amount had been met for the state of service.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Benefit amount have been met. So he got a, a limit on what he, what he can do.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, this is a limited indemnity medical plan.
[CUSTOMER][NEUTRAL] Limited
[CUSTOMER][NEUTRAL] Medical plan.
[CUSTOMER][NEUTRAL] So did you, you didn't pay anything on it?
[AGENT][NEUTRAL] Let me check. I do see another one. I'm going to see if this is the same we might have received a duplicate. Bear with me just a moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, cause it looks like we got a payment for 2300. Was that from you all?
[AGENT][NEUTRAL] Let me check again. I think this might have been a a duplicate bear with me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yes, I apologize. I was looking at the duplicate that was sent a bit more recently, but yes, we did, um, that was met their maximum was the 2300, yes, uh, did you need that claim number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] So the max was 2300.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And you don't, you don't know when he maxed out, do you?
[AGENT][NEUTRAL] It's uh per this um I believe it's per date of service.
[AGENT][NEUTRAL] Let me check this policy real quick. Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the policy is no longer active, but it was, he had um a first occurrence hospital confinement benefit that was the [PII].
[AGENT][NEUTRAL] And then let me see the 300.
[AGENT][NEUTRAL] Was the uh daily hospital confinement.
[AGENT][NEUTRAL] So those were the only benefits payable for this claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So when you say daily hospital confinement, was he limited to how long he could be in the hospital?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] As this was, I believe it paid $100 per day.
[CUSTOMER][NEUTRAL] $100 a day.
[AGENT][POSITIVE] Yeah, that's what I do believe so.
[CUSTOMER][NEUTRAL] OK. Now,
[CUSTOMER][NEUTRAL] Is, is the patient responsible for anything?
[AGENT][NEUTRAL] We don't say what is patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] Up to the provider.
[AGENT][NEUTRAL] Yes, we don't say what is patient responsibility.
[CUSTOMER][NEUTRAL] I mean, but if he has a, a limited of 20 to $300 100 dollars a day.
[CUSTOMER][NEUTRAL] Uh, he could be responsible for the balance.
[CUSTOMER][NEUTRAL] But y'all don't say what he's responsible for.
[AGENT][NEUTRAL] Yeah, that would be up to the provider, no, we do not.
[CUSTOMER][NEUTRAL] OK. OK. All right. So, um
[AGENT][NEUTRAL] If you'd like, [PII], I can send you a copy of this EOB if you need that.
[CUSTOMER][NEUTRAL] I think I may have it. I have to look in another system if I can bring it up.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] But let me, let me check right quick baby, see if I do have it.
[AGENT][NEUTRAL] Mhm. Sure.
[CUSTOMER][NEGATIVE] Uh, come on, ain't this way.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I got a check stuff.
[CUSTOMER][NEUTRAL] Yeah, you did $300 daily and annual first occurrence, $2000. Yeah, I got it. OK, alright, so what is your reference number?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Uh so my name is spelled [PII] A R A. last initial is A.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Was there anything else I could help you with [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, that's the only one I have for you. I appreciate your help and you have a good rest of your day.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] All right, yes, ma'am. You too. Thank you. Bye bye.
[CUSTOMER][NEUTRAL] All right. Bye-bye.