AccountId: 011433970860
ContactId: abdd83ae-cb88-4a41-b0e5-43a1be26db27
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 296529 ms
Total Talk Time (AGENT): 113820 ms
Total Talk Time (CUSTOMER): 122468 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/abdd83ae-cb88-4a41-b0e5-43a1be26db27_20250114T13:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], it's [PII]. I'm calling about my claim.
[AGENT][NEUTRAL] Your name is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, are you calling from a provider's office or are you the policy holder?
[CUSTOMER][NEUTRAL] I'm policy holder.
[AGENT][NEUTRAL] OK, if I can get your policy number, please?
[CUSTOMER][NEUTRAL] It's 02286543 ML 7 or 8 it's two numbers.
[AGENT][NEUTRAL] And what
[AGENT][NEUTRAL] OK, and what's a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the patients, uh, what is your date of birth and your mailing address, [PII]?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And what's your email address on file?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, thank you for verifying the information, [PII], and you said that you're checking a claim status?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, we can assist with that information. What's the date of service and the total charge?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the total charge date of service it's oh hold on it's uh [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what's the amount?
[CUSTOMER][NEGATIVE] It's I see they claim for the 1200 but you pay only for 183 and they sent me the bill for 31687 cents.
[CUSTOMER][NEGATIVE] And I just worried I don't know.
[CUSTOMER][NEUTRAL] You, you cannot pick up more.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is this the hospital charge or is it the surgeon's charge?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh, this is the, hm, this is the for colonoscopy and endoscopy.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Anesthesiology everything together.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So they're billed separately. So are you calling on all of them?
[CUSTOMER][NEUTRAL] It's uh looks like you know the the bill that I received from them, it looks like both of the anesthesia, colonoscopy, endoscopy medication.
[CUSTOMER][NEUTRAL] Uh, everything together.
[CUSTOMER][NEUTRAL] And I see you received the claim for 12116619.
[CUSTOMER][NEUTRAL] And the paid off provider it's 183 13 only.
[AGENT][NEUTRAL] Looking
[CUSTOMER][NEUTRAL] Hello? Oh OK.
[AGENT][NEUTRAL] And and what, what, what amount was paid?
[CUSTOMER][NEUTRAL] It's you pay only the 183 13 cents.
[AGENT][NEUTRAL] OK, so that's where the hospital charge.
[AGENT][NEUTRAL] And that is the maximum benefit that was available at the time. So the maximum outpatient benefit under this policy is $500 per calendar day.
[AGENT][NEUTRAL] And so there were other charges in addition to the facility charge for the same date of service.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and so when we receive the facility charge or the hospital charge, the remaining benefits.
[AGENT][NEUTRAL] Um, was 183 13, so that was all we were able to um pay.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] It's a for hospital charge.
[AGENT][NEUTRAL] That's the facility charge. We did pay the surgeon's charge and we did pay the anesthesiologists charge as well. It looks like there was a lab charge that we paid as well. So what we paid for those other claims plus the hospital claim totals $500 which is your daily benefit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK dokey, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] All righty. Any other questions, [PII], I can help out with today?
[CUSTOMER][NEUTRAL] Mm nope mm mm.
[AGENT][NEUTRAL] OK, thank you for calling APL.
[CUSTOMER][MIXED] I hope that you can pay all of them, but OK.
[AGENT][POSITIVE] Yeah, we paid as much as we could with the benefit that you have.
[CUSTOMER][POSITIVE] OK thanks mhm.
[AGENT][NEUTRAL] Alrighty, any other questions?
[CUSTOMER][NEGATIVE] Mhm bye bye no thanks.
[AGENT][POSITIVE] Alright, thanks for calling APL have a good day.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye.