AccountId: 011433970860
ContactId: 8b73c854-aa30-4cd9-a305-475c4d189f30
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 441799 ms
Total Talk Time (AGENT): 192700 ms
Total Talk Time (CUSTOMER): 193731 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/8b73c854-aa30-4cd9-a305-475c4d189f30_20250213T21:40_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hello. Uh, my name is [PII], and I'm calling uh regarding uh a letter I got, um, for a payment of benefits, and I, I'm kinda confused about it. Uh.
[CUSTOMER][NEUTRAL] Give me one moment here. I could give you the claim number if you like.
[AGENT][NEUTRAL] Uh, what's the policy number and claim number, [PII]?
[CUSTOMER][NEUTRAL] Yeah, I can give you both. Uh, policy number is 02543325.
[CUSTOMER][NEUTRAL] And then let me know when you're ready for the claim number.
[AGENT][NEUTRAL] OK, and that claim number?
[CUSTOMER][NEUTRAL] Um, 356-0081.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yeah, uh, [PII].
[AGENT][NEUTRAL] OK, and Mr. [PII], verify your date of birth, mail address and email address, please.
[CUSTOMER][NEUTRAL] Uh, date of birth [PII], mailing address [PII].
[CUSTOMER][NEUTRAL] Or I'm sorry, [PII], and then what was the last thing you needed?
[AGENT][NEUTRAL] Uh, email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, it sounds like what you received is an EOB about a claim that was received for you for data service, [PII] from Samaritan Hospital of Troy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And it looks like the claim processed as a duplicate. It looks like we previously received it.
[AGENT][NEUTRAL] And let's see October.
[CUSTOMER][NEUTRAL] Oh, maybe it's them trying to, maybe they tried uh processing it through and you're, I don't know, um.
[AGENT][NEUTRAL] It looks like we received it previously and it paid.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hm, hold on one quick moment. Let me look at this.
[AGENT][NEUTRAL] 1932.
[AGENT][NEUTRAL] OK, it looks like a provider submitted a claim um previously and we paid.
[AGENT][NEUTRAL] Them, well, it would look like a split pay. We had paid the provider.
[AGENT][NEUTRAL] Oops, no, not that much.
[AGENT][NEUTRAL] $83.
[CUSTOMER][NEUTRAL] You know, that's it, it probably should be.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And then we paid you $67. Did you receive a check for $67?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Yeah, that sounds about right.
[AGENT][NEUTRAL] OK. That, um, and the reason why is because under your policy, it
[AGENT][NEUTRAL] Isn't indemnity plan, meaning we just pay the amount that's payable for certain procedures like this one looks like it was for wellness and the wellness benefit pays $75 per.
[AGENT][NEUTRAL] Per treatment up to $250 and so,
[AGENT][NEUTRAL] Since the provider for one charge only charged $8 that's just how much we pay them and so the rest went to you.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEGATIVE] OK, well, I guess maybe they need to bill me. I don't know. I just wanna make sure that I, I mean, do I, do I pay you guys? Do I owe something? I'm just, I just wanna make sure that this doesn't come back to bite me. I'd rather just pay it up front or, you know, what have you.
[AGENT][NEUTRAL] Well, it's not that you have to pay us, but I would uh suggest you can contact that provider just to verify if there's any balance remaining for that data service because there was a total charge amount.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Let's see, well, it's.
[AGENT][POSITIVE] Oh [PII] it's so much fun. Give me one moment.
[AGENT][NEUTRAL] It looks like a total charge of $323 of that we to the provider, we paid $83.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Fill up the balance of.
[CUSTOMER][NEUTRAL] And then meet us to 67.
[AGENT][NEUTRAL] Yeah, so left a balance of 240, it seems, so you can contact them unless you have any other insurance because it looks like it was for wellness.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah, it was just a basic checkup, um, like a like a like a rundown that's, that's, I mean.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That was the essentially what it was and uh.
[CUSTOMER][NEGATIVE] Yeah, I just wanted to make sure because I'm like I'm trying to figure out like what's like I got this, uh, I got this mailing and I'm like, wait, what's going on? And then I tried looking for um like I'm waiting for them to bill me like with the remainder, so I didn't know like who to go to. I honestly, I'm at this point, I'm just not gonna bother using you guys because you're just proof of insurance at this point just so I don't get taxed, um.
[CUSTOMER][NEUTRAL] But yeah, like.
[CUSTOMER][NEUTRAL] Uh, yeah, because I'm, I'm trying to find out, um.
[CUSTOMER][NEUTRAL] Yeah, I just want to make sure like there was nothing else that uh.
[CUSTOMER][NEUTRAL] Like I needed to do with you guys in this regard um.
[AGENT][NEUTRAL] Nothing with us, no, sir. Uh, because like I said, it looks like the provider submit the claim, so I would say to contact them just to verify if there's any kind of balance, but, um, there's nothing you owe to us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright then then yeah I'll uh I'll check in my I'll check with them and make sure everything else is kosher um.
[CUSTOMER][NEGATIVE] Another question I had, and I don't know if you'd be the person to ask this, so I, there's a medication I need to get. Um, and I've tried running my insurance through, uh, the pharmacy, but it seems like you guys don't cover any medications or it doesn't even go through. So, um, do you guys, uh, do, under my policy, do I have health insurance or health insurance?
[CUSTOMER][NEUTRAL] Do I have prescription coverage? Cause I, I was under the impression you guys at least paid like 20 bucks for like whatever over the counter medica or not over the counter, whatever prescriptions I get minimum if it's generic.
[AGENT][NEUTRAL] Well, not with our company. Um, I don't know if you have your card in front of you, but there should be a number to farm avail, and that's
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That's who will help as far as any prescriptions. That's a separate company.
[CUSTOMER][NEUTRAL] Uh, so essentially, I have to go through them.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I, I see because it's like what an online pharmacy or something?
[AGENT][NEUTRAL] Um, I'm not sure what kind of pharmacy, but usually, um, they're the ones the first, uh, pharmacist will contact to verify any kind of um prescription coverage or if there's a discount for prescriptions. Yes, sir.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] I see. OK, then. I'll um
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome. Uh, is there anything else I can assist you with today?
[CUSTOMER][POSITIVE] Uh, no, you've got plenty. Thank you.
[AGENT][POSITIVE] Uh, yes, sir. Thank you for calling APL. Bye.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Yup, bye.