AccountId: 011433970860
ContactId: 90ce287c-d2dc-4733-8f11-f9ac28f6b542
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 522669 ms
Total Talk Time (AGENT): 167582 ms
Total Talk Time (CUSTOMER): 172305 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/90ce287c-d2dc-4733-8f11-f9ac28f6b542_20250103T16:29_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi, [PII]. My name is uh [PII] and I'm calling you from provider office.
[AGENT][POSITIVE] Yes, [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Uh, I'm looking for the status of one claim.
[AGENT][NEUTRAL] OK, you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Yes, and I have a specific question for this claim as well.
[AGENT][POSITIVE] Yes, I can help you.
[AGENT][NEUTRAL] You have what? I'm sorry. You have a specific question?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, I said, I, yeah.
[AGENT][POSITIVE] Yes, I can help you. What is your callback number?
[CUSTOMER][NEUTRAL] Yes, the callback number is [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] Yeah, it's uh D as in Delta 43301717.
[AGENT][NEUTRAL] OK, now that bra is not the policy number for American Public Life. Do they also have a policy with American Public Life or were you trying to reach 90 degree benefits?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let me check. Please allow me a moment.
[CUSTOMER][NEUTRAL] Uh, that is the only policy number that I have. And, uh, already the call was transferred to the another number, but, uh, they told us that, uh, this is, this claim is related to the anesthesia. So we need to, uh, so she transferred this call to this line.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, do you have the full social? OK, so I can't look up the member's information. Do you have the policy number for our company?
[CUSTOMER][NEUTRAL] Uh, can I provide you the claim number?
[AGENT][NEUTRAL] What is the claim number, [PII]?
[CUSTOMER][NEUTRAL] Yeah, it's 327-839-8.
[AGENT][NEUTRAL] 327-839-8
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And any information that I provide will be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, it's uh [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Data service and total bill amount.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Allow me a moment. The total bill amount is $1200 and the date of service is uh [PII].
[AGENT][NEUTRAL] OK. And how can I help you with this claim, [PII]?
[CUSTOMER][NEUTRAL] Yeah. Uh, so we built this claim for the amount of $1200 and uh it's a claim of uh anesthesia, but uh we received only $20.30 as a payment on this claim and we build 8 units for the service. Can you please check once again?
[AGENT][NEUTRAL] Yes, that is the, on this claim, that is the maximum benefit payable. That was the payable amount. This is not a major medical policy. This is a hospital indemnity limited benefit plan.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm. And uh uh what is the max benefit limit for this policy?
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] Give me a moment, [PII] for some additional information.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so the anesthesia benefit on this policy, [PII], and again, any information provided is a verification of benefits and not a guarantee of payment. Is the anesthesia benefit amount is 25% of the surgical benefit amount.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The maximum surgical, yes. So that's where the $20.30 came from.
[CUSTOMER][NEUTRAL] OK. Uh, so, uh, you calculate, uh, you calculate 25% on, on which amount?
[AGENT][NEUTRAL] This is not my
[AGENT][NEUTRAL] We, we do not.
[AGENT][NEUTRAL] I'm sorry, said it, it's based on the surgery charge.
[CUSTOMER][NEUTRAL] OK. So you are saying that uh uh 2025% of the surgery charge is $20.30.
[AGENT][NEUTRAL] Based on this calculation for this formula, yes, sir.
[CUSTOMER][NEUTRAL] Allow me a moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] So on
[AGENT][NEUTRAL] Let, let me do some calculating, [PII].
[CUSTOMER][NEUTRAL] Uh, can you please, uh,
[AGENT][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Allow me a moment. Uh, one minute, 221.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, can you please provide me the details of the, uh, surgical?
[CUSTOMER][NEUTRAL] Claim
[AGENT][NEUTRAL] No, sir, I can't because that's related to a different provider.
[AGENT][NEUTRAL] Charges
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you very much. And uh
[CUSTOMER][NEUTRAL] Allow me a moment. Uh, so the rest of the amount is uh patient responsibility or what?
[AGENT][NEUTRAL] We do not determine patient responsibility, [PII]. That would be up to the provider. Again, this is not major medical insurance. It's a limited.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hospital indemnity limited benefit plan.
[CUSTOMER][POSITIVE] I got it. Thank you very much. So, may I have the call reference number, please?
[AGENT][NEUTRAL] Sure, it would be my name and today's date, and if you need a copy of the explanation of benefit [PII], you can also obtain that by going to our portal at [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. Uh and uh uh I'm sorry to uh confirm it again. Your name is [PII], am I right?
[AGENT][NEUTRAL] Yes, sir. Actually, I, the last letter of my name is [PII] Yes, sir. Well, you're very welcome. So, is there anything else, [PII]?
[CUSTOMER][POSITIVE] Thank you very much, [PII].
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][POSITIVE] That's all for the day. Thank you very much for all the information on this claim. Have a nice day bye bye.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] I hope you have a nice day as well and thank you again for calling [PII].