AccountId: 011433970860
ContactId: a40d9423-7cd6-42a0-b187-5cf97acabeb4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 260059 ms
Total Talk Time (AGENT): 126810 ms
Total Talk Time (CUSTOMER): 95264 ms
Interruptions: 2
Overall Sentiment: AGENT=1.4, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/06/a40d9423-7cd6-42a0-b187-5cf97acabeb4_20250606T19:13_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII] calling from a medical provider's office. I have a question regarding two claims that process for a member.
[AGENT][NEUTRAL] OK, sure. I can assist you with claims and I'm sorry, you said [PII] for your name?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] How do you spell it? I'm sorry.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. What's the name of the facility you're calling from, Ms. [PII]?
[CUSTOMER][NEUTRAL] Swedish Health Services.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Uh yeah, policy number is 02581912.
[AGENT][NEUTRAL] Thank you. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, [PII]. Uh date of birth, [PII].
[AGENT][POSITIVE] Perfect, thank you. And may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] So one of them uh [PII] and it was for $376 even.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] And you say you have more than one for this member?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, yes, it's another claim for a data service 220 of 25.
[AGENT][NEUTRAL] The same amount.
[CUSTOMER][NEUTRAL] Same amount, 376, yes.
[AGENT][NEUTRAL] All right, thank you. OK, let me pull this explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, so it looks like we processed the claim on, let's see, and this is the one for [PII]. We processed the claim on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 25 and we send a benefit amount of $50 which is the maximum payable benefit for this office.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK no problem.
[CUSTOMER][NEUTRAL] OK. So then, um, so is there a patient responsibility? Was that the, was that the maximum?
[AGENT][NEUTRAL] Um, yeah, well, there's, yeah, well, we are a limited hospital indemnity plan, so we pay a flat amount. The flat amount is $50. So any remaining balance is up to the provider's discretion. We don't have any contractual involvement on the remaining. Yeah, we don't know if, if they have any other major medicals out there. We only offer this limited to them. Mhm.
[CUSTOMER][NEUTRAL] So the balance
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Do you need the claim number on this one, for this one? OK.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Um, no, I have it. It's just the way it came over, um, electronically in the payment post. It, it's just kinda looked a little strange, but I do see the payment and the claim number 33, uh, claim number I have is 3562653.
[AGENT][POSITIVE] Got you.
[AGENT][POSITIVE] Got you.
[AGENT][POSITIVE] Yes, that is correct. Yes. Mhm. All right, and.
[CUSTOMER][POSITIVE] OK. OK. And then this other one, right, thank you.
[AGENT][NEUTRAL] Yeah, the one for $220 was also processed on, on this one was processed on [PII], the same thing we send the $50 which is the maximum benefit of flat fee.
[CUSTOMER][NEUTRAL] Mm mm, OK, it's a limited benefit plan. OK, got it. Well, thank you. And was your um I'm sorry, I didn't write down your name.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] My name is [PII]. Is there anything else I may help you with today? Thank you?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] M
[CUSTOMER][NEUTRAL] Um, that's it. Do you, do you provide call reference numbers?
[AGENT][NEUTRAL] We don't. You can use my name in today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, got it. All right. Well, thank you. Have a good weekend.
[AGENT][POSITIVE] You're welcome. You as well, and thank you for calling APL. Have a good weekend. Bye bye.
[CUSTOMER][POSITIVE] Thank you. Thank you. Bye-bye.
[AGENT][NEUTRAL] Yeah.