AccountId: 011433970860
ContactId: 8f1d1e6e-2b34-47b7-bbd7-95ab54b6b3b3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 183820 ms
Total Talk Time (AGENT): 119043 ms
Total Talk Time (CUSTOMER): 57181 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/8f1d1e6e-2b34-47b7-bbd7-95ab54b6b3b3_20250123T19:12_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. With whom am I speaking? How may I help you?
[CUSTOMER][NEUTRAL] Hey Ms. [PII], my name is [PII], and I'm with um Plaqueman Parish Government Ambulance Service.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I hope I'm in the right department. I need to check on a claim.
[AGENT][NEUTRAL] And of
[AGENT][NEUTRAL] Checking claim status.
[CUSTOMER][NEUTRAL] Well, not a claim. Well, actually not a claim they made a payment on it, but what I need to find out is this patient plan a self-funded plan or a fully funded plan.
[AGENT][NEUTRAL] OK, what's a good call back number for you in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes ma'am, it's [PII].
[AGENT][NEUTRAL] All right. And what's the policy number you're calling regarding?
[CUSTOMER][NEUTRAL] Uh, policy number is 021-98600.
[AGENT][NEUTRAL] OK, thank you for that information, Miss [PII]. So I'm gonna get that pulled up and then I'm gonna have you verify some information, then I'll be able to assist you. um, I can't tell you whether policy is funded or not. Uh, I can just only assist you with the payment and how it was made, so give me one moment to get that pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. What's the member's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you and what's the data service that we're looking at and charge them out?
[CUSTOMER][NEUTRAL] Alright, it's an older data service 6722.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Um, total bill amount $1,539.40.
[AGENT][NEUTRAL] OK, so thank you for verifying that information. So, uh, verification of coverage does not guarantee the payment of a claim. Uh, these, this is a secondary gap supplemental insurance, so we don't, it's not like the primary insurance Blue Cross, Cigna, where this is fully funded, partially fund this is just a gap insurance that is provided to the uh patient through their employer.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And we pay a deductible, a co-pay or co-insurance to the responsibility that's listed on the primary EOB. In this case, the patient's responsibility was paid on this claim, uh, it looks like the EOB.
[AGENT][NEUTRAL] Uh, for, uh, Hicks fix code 80427 we modify your HR so that the patient was responsible for 67386. We paid 57386 because $100 goes toward the deductible. They were responsible for $100.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm OK.
[AGENT][NEUTRAL] And for uh Hicks fix code A0425 modifier RH, uh, the responsibility was 4812 and we paid 4812. OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] All right, anything else I can help you with today?
[CUSTOMER][NEUTRAL] Um, no, ma'am. That's it.
[AGENT][POSITIVE] Alright, well thank you for calling APL Ms. [PII]. You have an awesome day and take care.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Um, by