AccountId: 011433970860
ContactId: a996fdb1-4833-4dee-94ad-c09ce1210bfd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 511769 ms
Total Talk Time (AGENT): 264701 ms
Total Talk Time (CUSTOMER): 246535 ms
Interruptions: 9
Overall Sentiment: AGENT=1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/a996fdb1-4833-4dee-94ad-c09ce1210bfd_20250407T17:22_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] and I'm calling from Franciscan Physician Network, and I'm calling to um check on the status of a claim for a patient of ours.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, [PII], so you're needing claim status for one of your patients, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, yes ma'am. Well, I can help you with that, and [PII], uh, first off, what is a good call back number for you?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's [PII] and for my notes, can I get your name too? I'm sorry.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Again, my name is [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you. I didn't write it down and then all the names blur together.
[AGENT][NEUTRAL] Yes, I am. Uh it's OK.
[AGENT][NEUTRAL] I understand. No worries. All right. And [PII], what is your patient's policy number?
[CUSTOMER][NEUTRAL] Oh. Yeah.
[CUSTOMER][NEUTRAL] Um, I have 250-544-9.
[AGENT][NEUTRAL] OK, that was 250-5449. Is that correct?
[CUSTOMER][NEUTRAL] Yes, that's what I have. Let me see if that's.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, give me just a moment to get the member's information pulled up please.
[AGENT][NEUTRAL] OK, and any information that I do provide for you will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It is [PII], and her date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] And it's not her, it's him. I'm sorry.
[AGENT][NEUTRAL] [PII], yeah, OK.
[CUSTOMER][NEUTRAL] Yeah, [PII] I think can go either way, but I maybe it's spelled different for a boy, a girl I don't know.
[AGENT][NEUTRAL] It can.
[AGENT][NEUTRAL] Yeah, I've never seen it spelled like that, the way she spells it or he spells it, I'm sorry. You said she and then I said she.
[CUSTOMER][NEUTRAL] I know, me either. That's why I thought it was a girl.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh yeah, yeah.
[CUSTOMER][NEUTRAL] Well, that spelling, I thought, oh, that's probably a girl. Nope.
[CUSTOMER][NEGATIVE] It is not.
[AGENT][NEUTRAL] No, ma'am, I see it, yes, I do see it as a mail. OK. And what is the date of service, Renee, in total bill amount, please?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It's [PII] and the bill amount was $180.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you, and again, any information that I do provide would be a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] One moment. And 826 2024 for 180, correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I do see that this claim was received. It was received [PII] of this year.
[AGENT][NEUTRAL] And it was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 354.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 921 5.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There was a benefit paid in the amount of $50.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the remark on this claim, Renee states with this check, the maximum benefit payable for this state of service has been met.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and do you show, um, what was the check number?
[AGENT][NEUTRAL] OK, it was on a single check and it's check number 202.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] 1892 and this just does still show as open outstanding it shows from what I can tell is outstanding. Um, can you verify the address?
[CUSTOMER][NEUTRAL] OK, and was, yeah, go ahead.
[CUSTOMER][NEUTRAL] It does.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah it should go to let me pull up the.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It should go to Franciscan physician Network at [PII].
[AGENT][NEUTRAL] Mhm. Mhm.
[AGENT][NEUTRAL] Yes, ma'am, and that is what I show.
[CUSTOMER][NEUTRAL] OK, do you show when it was sent though? Like, is it [PII].
[AGENT][NEUTRAL] Well, it was an issue, the issue date was [PII]. So, let me look to see what, mm, so it should have been mailed out the next day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, I mean, we're talking, well, let's say so that [PII] would have been on a Wednesday. So, you know, it should have mailed out on Thursday at the very latest, if there was some type of delay, it would have been on Friday, you know, the [PII] or [PII].
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, alright, so we have not, we're not showing that we received that at all. um I did receive the one we did receive the one for the July payment which was sent out on.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, well, I don't know what it, well let me see when it was sent. I don't, I'm not sure when that one was sent, but we did receive that payment, um, but this one, I, we're not showing that we received it. So has it been long enough that you can do like a tracer and have it redone, or no?
[AGENT][NEUTRAL] Um
[AGENT][POSITIVE] Yes, ma'am. I can send a request to have it verified that it's still outstanding and to get approval to void and reissue. I can do that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][POSITIVE] OK, perfect. OK, perfect.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I will do that for you and if you need a copy of the explanation of benefits, [PII], you can go to our portal which is located at [PII] and you should be able to print that if you need that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, let me see here.
[CUSTOMER][NEUTRAL] I think I'm on it right now so let me see if I can, yeah, if I can print that.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, yes, it's showing me.
[CUSTOMER][NEUTRAL] It is showing me that so I can get that EOB so that's great um now when they reissue the check, the claim number is not gonna change, right? Like it'll stay the same.
[AGENT][POSITIVE] OK, good. OK.
[AGENT][NEGATIVE] It should not. Yeah, it shouldn't. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, all right, um, and then like how long should I wait to check back and see if.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] You know if it if the tracer came through and it was not it was still outstanding and so forth.
[AGENT][NEUTRAL] I would give it a week to check on, you know, just that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Cause I'll have to send the request to our finance, yeah, and then, you know, it'll have to come back to claims to be reissued if it's still showing and then mailed out and then it typically takes, you know, roughly 10 business days for it to be received once it's been mailed.
[CUSTOMER][NEUTRAL] OK, that part right.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got you. And then, um, per that EOB too, you said it that the benefits have been maxed. So does that mean that
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] For that data service, yes, ma'am.
[CUSTOMER][NEUTRAL] Oh, for that date of service, OK, not for the coverage, OK.
[AGENT][NEUTRAL] This is not a major medical plan.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] So this is a hospital indemnity limited benefit plan. So, yes, for this date of service,
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] That was the max benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and on our end we're we're showing that this coverage is no longer active, is that true?
[AGENT][NEUTRAL] Uh, that is what I show, yes, ma'am, I show that this policy did turn. Mhm.
[CUSTOMER][NEUTRAL] At all? OK.
[CUSTOMER][NEUTRAL] Did term OK alright because that's what we show on our end too. I just wanted to make sure so that we don't send anything right perfect and I will um check back in a week. Oh, and [PII], do you give reference numbers?
[AGENT][POSITIVE] Yes, that is correct.
[AGENT][NEUTRAL] OK. Yeah.
[AGENT][NEUTRAL] You would use my name along with today's date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] All right, thank you, uh huh thanks.
[AGENT][POSITIVE] Well, you are certainly welcome, [PII]. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] That is it.
[AGENT][POSITIVE] All right, well then, thank you so much for calling APL and I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thanks you too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.