AccountId: 011433970860
ContactId: 8f464bdf-d2a5-451a-827d-2efe832375f5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 173800 ms
Total Talk Time (AGENT): 57607 ms
Total Talk Time (CUSTOMER): 78727 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/8f464bdf-d2a5-451a-827d-2efe832375f5_20250123T19:06_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL this is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I work for Salem Township Hospital, and I was going through one of our patients accounts, and we have an issue with one of the claims you guys paid on.
[AGENT][NEUTRAL] OK, um, [PII], can I get a good callback number?
[CUSTOMER][NEUTRAL] [PII] and my extension is [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. Um, can I get the policy number?
[CUSTOMER][NEUTRAL] Policy number.
[CUSTOMER][NEUTRAL] Is 02556914.
[AGENT][NEUTRAL] OK, thank you and [PII], can you confirm the insured's name and date of birth for me?
[CUSTOMER][NEUTRAL] Uh, I think it's [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And you said there was an issue with the claim that we paid on, do you have that claim number or data service and build amount?
[CUSTOMER][NEUTRAL] I have your guys' claim number it's 354-474-2.
[AGENT][NEUTRAL] OK, let's take a look.
[AGENT][NEUTRAL] OK, so what is the issue here? We'll definitely take a look at it.
[CUSTOMER][NEUTRAL] Well, the, the claim itself is, uh, it's actually two claims.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] But this one that I'm looking at it, it the build amount was $19,057.
[CUSTOMER][NEUTRAL] And you guys paid $75 of that.
[CUSTOMER][NEUTRAL] And then it says max benefit.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] It's been reached.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] It doesn't explain if like patient responsibility deductible um.
[CUSTOMER][NEUTRAL] Another insurance carrier.
[CUSTOMER][NEUTRAL] Is the rest of it all patient responsibility?
[AGENT][NEUTRAL] OK, so you're, you just have questions I guess what the balance would be or anything like that?
[CUSTOMER][NEUTRAL] Yeah, I mean it just says $75 for the um outpatient sickness benefit.
[AGENT][NEUTRAL] OK, so this is a hospital indemnity plan, so it's a limited benefit plan.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So the remaining balance, that's gonna be up to the provider or the facility whether it's gonna be provider write-off or patient responsibility.
[AGENT][NEUTRAL] APL cannot advise that information.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, that'll be it.
[AGENT][POSITIVE] OK, well thank you for calling APL and I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Alright bye bye.