AccountId: 011433970860
ContactId: ad9e6f6a-b93a-487c-8342-e63d01d31032
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 447130 ms
Total Talk Time (AGENT): 158391 ms
Total Talk Time (CUSTOMER): 127148 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/ad9e6f6a-b93a-487c-8342-e63d01d31032_20250325T18:16_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from the product office. I'm here to check on the claim status.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the claim status, [PII]. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Only one
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] it's a direct line.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Sure, it's D as in Delta.
[CUSTOMER][NEUTRAL] 435
[CUSTOMER][NEUTRAL] 10,820
[AGENT][NEUTRAL] OK, and do you have a copy of the member's ID card available?
[CUSTOMER][NEUTRAL] Mm. Just can I double check it.
[CUSTOMER][NEUTRAL] Uh, I didn't find the member's ID code on my system.
[AGENT][NEUTRAL] OK, because the ID number that you gave us for 90 Degree benefits. Um, do you have the member, I can look the member up with their full social or their first and last name?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh, I can provide you the first and last name.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The first name is [PII]. The last name is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] And her first name is [PII]. Hold on one moment.
[AGENT][NEUTRAL] So I'm waiting to see if there's a um policy on file searching. Hold on one moment.
[AGENT][NEUTRAL] And do you have a claim number for the claim?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, just a moment, uh.
[CUSTOMER][NEUTRAL] I do have that one with me.
[AGENT][NEUTRAL] OK, I think it, I think the policy just popped up actually. Is this for their medical or what type of policy?
[CUSTOMER][NEUTRAL] Medical
[AGENT][NEUTRAL] Medical.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So the policy number is 255.
[AGENT][NEUTRAL] 8899.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And may I have the date of service for the claim you like me to check on?
[CUSTOMER][NEUTRAL] It's for [PII].
[CUSTOMER][NEUTRAL] And it's totally billed for $4,439.90.
[AGENT][NEUTRAL] $4,439.90.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Westar Kennystone Hospital.
[AGENT][NEUTRAL] Alright, [PII] we received the claim on [PII].
[AGENT][NEUTRAL] Claim number is 354.
[AGENT][NEUTRAL] 5473.
[AGENT][NEUTRAL] And on [PII], the claim was paid out on to the provider, a total of $50.
[CUSTOMER][NEUTRAL] OK. And is it a patient responsibility?
[AGENT][NEUTRAL] Um, so we don't determine patient responsibility because we're not a major medical insurance company.
[CUSTOMER][NEUTRAL] OK, but I need to know with that reason and the reason was mentioned but the claim has been paid only for $50. And the reason why?
[AGENT][NEUTRAL] Yes, the reason is the benefit amount. So for this policy, the benefit is $50 per emergency room visit up to 2 visits per calendar year. So that $50 was applied to this claim.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I'm sorry, could you repeat once again?
[AGENT][NEUTRAL] Sure, the benefit for this policy for emergency rooms is up to $50 per visit with a max of 2 visits per calendar year.
[AGENT][NEUTRAL] So the $50 was applied to this um claim.
[CUSTOMER][NEUTRAL] OK, which means as for the patient plan, you will allow uh only $50 for emergency rooms, right?
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Correct, the benefit is only 58.
[AGENT][NEUTRAL] The max is $50.
[CUSTOMER][NEUTRAL] OK. And the rest amount of 4000
[CUSTOMER][NEUTRAL] $389.90 can bill to the patient.
[AGENT][NEUTRAL] We do not determine patient responsibility, which is why it's not listed on the explanation of benefits. It would just be whatever your policy or procedures are for outstanding or remaining balances.
[AGENT][NEUTRAL] As the provider.
[CUSTOMER][NEUTRAL] OK. And may I know the patient's plan type?
[AGENT][NEUTRAL] Yes, this is a hospital indemnity policy.
[CUSTOMER][POSITIVE] OK. Thank you so much for that and uh
[CUSTOMER][NEUTRAL] Can I get the call reference number and your name once again, please?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name, which is [PII] The first initial to my last name is [PII], and then today's date.
[CUSTOMER][POSITIVE] Thank you so much and um have a nice day.
[AGENT][POSITIVE] You're very welcome. [PII], was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] Uh, nothing else. Thank you so much for your service. Have a nice day.
[AGENT][POSITIVE] You also, thanks for calling APL. Bye-bye.