AccountId: 011433970860
ContactId: 950f9259-1043-46ca-a2a7-b8e288971f0c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 202839 ms
Total Talk Time (AGENT): 127187 ms
Total Talk Time (CUSTOMER): 57580 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/950f9259-1043-46ca-a2a7-b8e288971f0c_20250220T21:09_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] For contacting HTO, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I received an explanation of benefits and I just I'm a little bit confused but I was wondering if I could just get some help.
[AGENT][NEUTRAL] Yes, I can certainly look that up. What is your policy number, please?
[CUSTOMER][NEUTRAL] Uh, it looks like 02586497.
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] OK, thank you. If I could verify your name, uh date of birth, and a phone number, please?
[CUSTOMER][NEUTRAL] So I'm actually with the provider's office.
[AGENT][NEUTRAL] OK. OK then.
[CUSTOMER][NEUTRAL] Um, my name is [PII].
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] [PII], OK, yes, and the uh the insured's name and date of birth, please, and I also need a, a callback number.
[CUSTOMER][NEUTRAL] OK, his name is [PII].
[CUSTOMER][NEUTRAL] His date of birth.
[CUSTOMER][NEUTRAL] [PII] and my callback number is [PII].
[AGENT][POSITIVE] I appreciate that. Uh how many, what day of service are we looking for, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] And you said that there was a uh
[AGENT][NEUTRAL] OK, remark code that you needed, that we needed to find.
[CUSTOMER][NEUTRAL] Well, it just says we are awaiting information to confirm eligibility from benefits in a card. I don't know what that means.
[AGENT][NEUTRAL] OK, so the um policy is through his employer.
[AGENT][NEUTRAL] And the uh employer each each week will let us know that the insured is still with their with their program usually these are uh places where they uh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, like staffing places, they'll, they'll be there, uh, for one week and then maybe not work the next week, that sort of thing. So what we do is we look for eligibility and the insured or excuse me, the employer lets us know that they're still with the program or they're still employed or, you know, they're still there, uh, to, to do, uh, you know, to still with the, uh, insurance.
[AGENT][NEUTRAL] And we didn't receive that at the time that your, your, um, that weekly uh um electronic uh report at the time that we received your claim. Now we did by the [PII] of this month, which would have been Monday. So what we did was we went ahead and paid the, the uh claim and you're going to receive a check in the amount of $55.20. Now, some of the benefit went towards his $50 deductible.
[AGENT][NEUTRAL] But the remaining benefit will be uh sent to [PII] and your check number is 202.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 7954, but that went out on Monday. It actually the, the check itself um went out on Tuesday. It was, it was processed on Monday, but it went out on Tuesday, so that should be coming to you just in time.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] You said it was for 55, how much?
[AGENT][NEUTRAL] Uh, $55 and let's see what else it was. Give me just a moment, please.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, it was $55.20.
[CUSTOMER][POSITIVE] OK, alright, that's all I needed to know if I needed to do anything, but it sounds like it's being taken care of, so I appreciate your help.
[AGENT][NEUTRAL] OK, there's nothing else to help with. Thanks for contacting API.