AccountId: 011433970860
ContactId: 9d131389-58bb-411f-b9ec-fcefef52813c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 478100 ms
Total Talk Time (AGENT): 128435 ms
Total Talk Time (CUSTOMER): 190010 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/9d131389-58bb-411f-b9ec-fcefef52813c_20250604T18:13_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. This is [PII]. I'm calling from the Jackson Hospital, uh, to check on your repos this claim.
[AGENT][NEUTRAL] OK, I'm happy to check on a claim. What's the policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, policy number starts with 02511314.
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] Chinese
[CUSTOMER][NEUTRAL] So yeah, [PII]. The bill amount is $175 even.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK, so I do show that we received this claim on [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Claim was processed [PII]. There was a benefit payment sent in the amount of $75 as a single check.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. Now, on [PII], the payment was sent for reprocessing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Why was it sent for reprocessing?
[CUSTOMER][NEUTRAL] It was paid more than the uh
[CUSTOMER][NEUTRAL] I mean it's a paid more.
[CUSTOMER][NEUTRAL] I mean what would be as per the primary UB.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] I don't see that we received any claim any other claims for the state of service.
[CUSTOMER][NEUTRAL] No, no, no. No, no, we, you made the payment. The claim was sent for reprocessing.
[CUSTOMER][NEUTRAL] On [PII] or [PII].
[AGENT][NEUTRAL] I don't see that we received anything additional. The $75 payment was the max benefit payable for the date of service.
[CUSTOMER][NEUTRAL] Yeah, one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, one moment please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It was
[CUSTOMER][NEUTRAL] Because Medicare, the primary Blue Cross Blue Shield paid and lift the balance of $35 only for this claim.
[AGENT][NEUTRAL] We don't have any sort of additional information as far as other insurance.
[AGENT][NEUTRAL] All I can tell you is what was submitted and paid to this insurance. I don't know whether they're secondary or not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No, ma'am, the thing is, Medicare paid, I mean, primary Blue Cross Blue Shield paid 61.06% with the patient responsibility only $35 even.
[CUSTOMER][NEUTRAL] When it forward to second email payment is $75.
[CUSTOMER][NEGATIVE] You should be paid 35 or less for this claim.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK, so the patient's plan is a limited benefit hospital indemnity plan. It pays a set amount depending upon what the patient is being seen for. There is no sort of percentages. So,
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] The benefit payment for a visit is $75. That's why that's what was paid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so you'll be paying sort of the, uh, I mean, OK, in the show.
[CUSTOMER][NEUTRAL] So you'll be paying 75 perspective of the primary payment, right?
[AGENT][POSITIVE] We are, we already processed a benefit of $75 and that was sent to the provider, yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so the, the payment was made to check or you?
[AGENT][NEUTRAL] It was a single check?
[CUSTOMER][NEUTRAL] Check number.
[AGENT][NEUTRAL] 201.
[AGENT][NEUTRAL] 6106.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] 20161.
[AGENT][NEUTRAL] 06.
[CUSTOMER][NEUTRAL] 06 is 2011, right? 2011, not 11 or 1.
[AGENT][NEUTRAL] 201.
[AGENT][NEUTRAL] 6106.
[CUSTOMER][NEUTRAL] OK, fine. You should have the check.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, it was cash, right?
[AGENT][NEUTRAL] Correct. I don't have a date. It was cached.
[CUSTOMER][NEUTRAL] The address of the check was sent to.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, fine. Is it possible to fax me the for this one?
[AGENT][NEUTRAL] What's the fax number?
[CUSTOMER][POSITIVE] Yeah, thank you.
[CUSTOMER][NEUTRAL] OK, and [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes. I'll put attention. yeah, attention, call.
[AGENT][NEUTRAL] OK. Give it about 5 minutes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else I can check on?
[CUSTOMER][NEUTRAL] And one more clarification, on [PII], uh, request was made for the reprocessing. OK. So, can you please check this was already sent for reprocessing on 227.
[CUSTOMER][NEUTRAL] 0 25
[AGENT][NEUTRAL] I don't see that anything was reprocessed on 227, no.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, fine, ma'am. No problem. Thank you very much. Uh.
[CUSTOMER][POSITIVE] [PII] thank you bye.
[AGENT][POSITIVE] You're welcome bye bye.
[CUSTOMER][NEUTRAL] Bye.