AccountId: 011433970860
ContactId: a9257e4d-c0cb-4432-b66a-77803bb848d7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 486109 ms
Total Talk Time (AGENT): 217371 ms
Total Talk Time (CUSTOMER): 123413 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/a9257e4d-c0cb-4432-b66a-77803bb848d7_20250415T15:07_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I am with Christa.
[CUSTOMER][NEUTRAL] Hospital?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I was needing to get claim status of um regarding a medical claim.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes ma'am, directly it's [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, I have D as in David 404-07416.
[AGENT][NEUTRAL] Thank you. And do you have a copy of the member's ID card available?
[CUSTOMER][NEUTRAL] Uh, let me see if I have a copy in his chart because I don't show one of this information that was entered in the system when they created his profile.
[AGENT][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] Because that D number is for 90 degree benefits, so we can't use that, but I can also search with the the full social if you have it.
[CUSTOMER][POSITIVE] Oh yes ma'am I have one and whenever you're ready.
[AGENT][POSITIVE] Yes, I'm ready.
[CUSTOMER][NEUTRAL] Um, OK, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Believe the policy is here. Can you verify the member's first and last name?
[CUSTOMER][NEUTRAL] I have [PII]
[AGENT][NEUTRAL] OK, this is
[AGENT][NEUTRAL] Thank you, you said this is for medical. Hold on, here it is.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] Oops.
[AGENT][NEUTRAL] 994 here we go.
[AGENT][NEUTRAL] All right, and I have her here. I just need you to verify her date of birth.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim and the total bills?
[CUSTOMER][NEUTRAL] Yes ma'am, 727-2023, it's a single date, and the total bill on the claim was for $11,262 total.
[AGENT][NEUTRAL] OK, hold on one moment. 23.
[AGENT][NEUTRAL] So the uh wait a minute, it's July.
[CUSTOMER][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Here we go.
[AGENT][NEUTRAL] OK. So I had to figure out which uh policy was active at that time. So hold on one moment, let me see if this is it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, so the active policy number was 2,334,600.
[AGENT][NEUTRAL] And I'm getting ready to look under that policy to see if there's a claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It was $11,262? Oh.
[CUSTOMER][NEGATIVE] Yes ma'am, with yeah, total no sense.
[AGENT][NEUTRAL] Do you mind if I place you on just a brief hold?
[CUSTOMER][NEGATIVE] No ma'am, not at all.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm. You are on hold.
[AGENT][NEUTRAL] OK, wait a minute now.
[AGENT][NEGATIVE] That one was denied, but this is HI so I can't do CLMI.
[AGENT][NEGATIVE] Um, it's not looking too good.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, wait, wait, wait, wait, wait, wait, is it the same claim? Hold on, I just figured it out.
[AGENT][NEUTRAL] 392 there you go.
[AGENT][NEUTRAL] Hey, go ahead, girl. OK, 369, I mean 639.
[AGENT][NEGATIVE] So then, oh, cause it's HI so it's not gonna show anywhere. Oh, I figured it out. OK, come on.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for the wait. So we received the claim on [PII].
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that claim number is 334.
[AGENT][NEUTRAL] 363 9.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim to the provider.
[AGENT][NEUTRAL] A total of $150.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And did you need the check information?
[CUSTOMER][NEUTRAL] Yes ma'am, um, so.
[CUSTOMER][NEUTRAL] You said it was $150. Was the did the patient have any responsibility?
[AGENT][NEUTRAL] So we don't determine patient responsibility because we're not a major medical.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So let me see. Yeah, that would be that would be uh up to you all as a provider or if they have another type of insurance, um, we just apply.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see the check.
[CUSTOMER][NEUTRAL] OK, so this is not a major medical plant policy. However, it's, um, a limited a um limited um pay it pays out a limited benefit.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, it's
[CUSTOMER][NEUTRAL] And that would be the maximum that it paid it's 150.
[AGENT][NEUTRAL] Yes, ma'am, um, it paid $100 to the diagnostic testing or to the, the CT and then $50 to the emergency room.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that was the maximum that it would was gonna pay out.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, got you.
[AGENT][NEUTRAL] Let me get that check information for you.
[AGENT][NEUTRAL] Um, so it was a single check, um, check number 1804808.
[AGENT][NEUTRAL] Um, in the amount of $150.
[AGENT][NEUTRAL] It was issued on [PII] um to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, correct, mhm.
[AGENT][NEUTRAL] And it cleared on [PII].
[CUSTOMER][NEUTRAL] OK [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Great.
[CUSTOMER][NEUTRAL] Alright [PII], if I can get a reference number I'll go and try and locate this payment.
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK great thanks again you have a great day.
[AGENT][NEUTRAL] You also, was there anything else I can help with?
[CUSTOMER][NEUTRAL] No ma'am, I think that's everything.
[AGENT][POSITIVE] Alright, thanks for calling APL. I hope you have a good day, [PII].
[CUSTOMER][POSITIVE] You too thank you bye.
[AGENT][POSITIVE] Thank you. Bye bye.