AccountId: 011433970860
ContactId: a836f7f7-aa96-4dcd-899f-4b972e55c638
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 258579 ms
Total Talk Time (AGENT): 86368 ms
Total Talk Time (CUSTOMER): 119693 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/a836f7f7-aa96-4dcd-899f-4b972e55c638_20250415T16:05_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. Did you say Evi?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] with the Electromed Incorporated. We're providers for a durable medical, so I'm not sure if I have the right.
[CUSTOMER][NEUTRAL] Department I guess but I'm checking on the status of a claim.
[AGENT][POSITIVE] Um, yes, ma'am. I can assist you with claim status. Um, first, could I get your name again? Mhm. You're welcome and a good callback number.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] You bet. This is.
[CUSTOMER][NEUTRAL] Yep, [PII].
[CUSTOMER][NEUTRAL] Direct line [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now, could I get the policy number, please?
[CUSTOMER][NEUTRAL] And that would be.
[CUSTOMER][NEUTRAL] 02141248. M as in Mary, L as in Lima, 8.
[AGENT][NEUTRAL] OK. Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] And that is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And what's the date of service and bill charges on the claim?
[CUSTOMER][NEUTRAL] [PII] $1,895.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK. Yes, ma'am. We received that claim on [PII].
[AGENT][NEUTRAL] It processed and paid out on [PII].
[AGENT][NEUTRAL] It paid out for 50.
[CUSTOMER][NEUTRAL] Is there any
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, oh yeah, thank you, yeah, thank you, [PII], um, I'm just wondering, is this like is there any patient balance or the explanation of benefits doesn't show if the patient owes the difference or do we adjust that?
[AGENT][NEUTRAL] Yeah, the patient would owe the difference because under this policy, we cover up to $500 per day for outpatient services. So if there's anything over the $500 that went towards the copay, the co-insurance, or the deductible, um, that will be patient responsibility.
[CUSTOMER][NEUTRAL] OK, so if primary pays a deductible and that was transferred down you only paid 500, so that's then the rest is the patient's balance for the difference.
[AGENT][POSITIVE] Yes, ma'am, that's correct.
[CUSTOMER][NEUTRAL] OK, that is what I'm that's what I'm wondering it's just it doesn't show that anywhere on the explanation of benefits so I'm just making sure so is this like just uh a funded thing or what what kind of coverage is this?
[AGENT][NEUTRAL] This is secondary gap insurance, um, where we cover the co-pay, the co-insurance, or the deductible, but for outpatient services, we only cover up to 500 per day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Per month then because we're billing monthly.
[AGENT][NEUTRAL] Well, no, it's still daily.
[CUSTOMER][NEUTRAL] OK, so then it would be 500 divided by 30 is what you pay daily then?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK, got it, got it. OK, sounds good. I think that makes sense um.
[CUSTOMER][NEUTRAL] Up to 500, OK.
[CUSTOMER][NEUTRAL] Alright, [PII], is there a reference number for our call today?
[AGENT][NEUTRAL] Yes, so the reference number, you can use my name in today's date. Um my last, uh my name is spelled [PII] Last initial is [PII] like [PII], and today's date. Um is there anything else I can assist you with?
[CUSTOMER][POSITIVE] There is not. Thank you very much. I appreciate your time and explanation.
[AGENT][POSITIVE] OK, no problem, [PII]. Thank you for calling ATL. You have a great rest of your day. Mm bye.
[CUSTOMER][POSITIVE] You as well thank you.