AccountId: 011433970860
ContactId: 8ee50459-956e-4766-83e6-14aa0ad0fdfb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 425640 ms
Total Talk Time (AGENT): 163189 ms
Total Talk Time (CUSTOMER): 76274 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/8ee50459-956e-4766-83e6-14aa0ad0fdfb_20250618T13:49_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Oh yes, I'm checking to see if you received a claim.
[AGENT][POSITIVE] OK, sure, I can assist you with claims and may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] I'm sorry, I didn't get the last four digits. Can you repeat? [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. And may I have the policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] D as in David, 43511.
[CUSTOMER][NEUTRAL] how many ones is that? 123. so it's D 43511154.
[AGENT][NEUTRAL] Do you see a policy certificate number? It's gonna start with a 0 followed by 7 digits. That's gonna be your number.
[CUSTOMER][NEUTRAL] OK, then that's what I have for her.
[AGENT][NEUTRAL] Are you coming?
[CUSTOMER][NEUTRAL] An ID number.
[AGENT][NEUTRAL] OK, are you calling from a provider's office or this is your policy?
[CUSTOMER][NEUTRAL] No, it's uh, I'm calling from the facility from the hospital.
[AGENT][NEUTRAL] OK. Um, what's the name of the hospital?
[CUSTOMER][NEUTRAL] Mount Cromwell Health.
[AGENT][NEUTRAL] OK. And let me have the spelling of the last name of the patient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] Wise [PII]
[AGENT][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] And the first name?
[CUSTOMER][NEUTRAL] [PII]. Um it's spelled [PII]
[AGENT][NEUTRAL] No no let me see if I can find it.
[AGENT][NEUTRAL] No, it's [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Any other names or last name besides wife?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, um, do you have any other information that I might use to pull her up? Like, do you have a social or anything like that?
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] Do you want the last four digits of the social?
[AGENT][NEUTRAL] Oh, we cannot use the last 4. It has to be the full social.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK thank you.
[AGENT][NEUTRAL] I.
[AGENT][NEUTRAL] All right. And what is her date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, perfect. Yes, sir. All right, and what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, how much is the total charge?
[CUSTOMER][NEUTRAL] And the total bill amount is $12,0017.80.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] All right, let me see if I can find this claim for you. And for future, you can check claim status online through our website at [PII]. And let's see, looks like it's going to be this one. Let me pull that image of the UB. One moment.
[AGENT][NEUTRAL] Mhm I'm waiting on the system.
[AGENT][NEUTRAL] It looks like we processed the claim on [PII] and we send a benefit amount of $150 to the provider.
[CUSTOMER][NEUTRAL] OK. Well, it was underpaid, so I'm trying to figure out why that is.
[AGENT][NEUTRAL] Oh, OK. All right. Um, so, um, Ms. [PII], this particular policy is a limited hospital indemnity plan, so it pays a flat amount based on the service. Um, for this particular service, there are two charges. One is the ER visit, the other one is the CT scan. Uh, for the ER visit, we only pay $50 per visit. For the CT scan, which is an imaging test, we only cover $100 and that is the reason we only send $150.
[AGENT][NEUTRAL] Again, this is a limited policy. We don't know if he has any other policies out there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, and can I get a reference number for the call?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's state if you will. Do you need to spelling of my name or any other information?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Sure, that's [PII]. And would you like the claim number? Will you have that information?
[CUSTOMER][POSITIVE] Um, I have the claim number, but thank you so much. You have a great day.
[AGENT][POSITIVE] You as well, Miss [PII]. Thank you for calling APO. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Bye-bye.