AccountId: 011433970860
ContactId: af08ebdf-8bf8-4f51-8193-9c8595da1a8d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 502109 ms
Total Talk Time (AGENT): 205457 ms
Total Talk Time (CUSTOMER): 130067 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/af08ebdf-8bf8-4f51-8193-9c8595da1a8d_20250228T19:57_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. Um, I got a letter in the mail uh regarding my claim, claim 3566042.
[AGENT][NEUTRAL] OK, [PII], what was, uh, you have a question regarding a claim that was reviewed, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes ma'am. Well, I can help you with that. What is a callback number for you please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And your policy number, please?
[CUSTOMER][NEUTRAL] It will be 02473403.
[AGENT][NEUTRAL] OK, thank you. So if you'll give me just a couple of moments to get all of your policy information pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and just, any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. I will need to verify several things first for security. So if you could first please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. Also your home mailing address, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you is the same as the one that you gave me, so that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you and the last piece of information to verify is your email. This does appear to be your work email.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Now the claim that you're calling in regards to, um, just, is it for yourself?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and what is, give me just one moment. You said it was 356-604-2, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I show that that claim was for Baptist Hospital for data service 12-18-2024.
[CUSTOMER][NEUTRAL] Right.
[AGENT][POSITIVE] OK, yes, ma'am. How can I help you with that today?
[CUSTOMER][NEUTRAL] My, my question is that the $300 was given to Baptists?
[CUSTOMER][NEUTRAL] They send it to?
[AGENT][NEUTRAL] Yes, ma'am. That benefit was paid to the facility, and the remarks on here state that with this check, the maximum benefit payable for this state of service has been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so the $300 was a part of maybe a copay or deductible that they send it to them?
[AGENT][NEUTRAL] Yes, ma'am, that is correct. And on your, on the supplemental policy, the maximum benefit per calendar day for covered outpatient services is $300.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, and then I have another pending one that they, they did send me the, they send me the code.
[CUSTOMER][NEUTRAL] The code um invoice so I have to scan that in and that will be for HCA um Memorial.
[CUSTOMER][NEUTRAL] HCA [PII].
[CUSTOMER][NEUTRAL] That I have pending um.
[CUSTOMER][NEUTRAL] To submit that.
[AGENT][NEUTRAL] OK, so that's fine. And uh do you also recently uploaded some information on the, I can't see what that information is because it's in line for review, but on the [PII].
[AGENT][NEUTRAL] It looks like we've received something and on the [PII], we've received something.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] From HCA?
[AGENT][NEUTRAL] I'm not sure who it's from. I would have to pull the um information up. Give me just a moment.
[CUSTOMER][NEUTRAL] Probably from Baptist because HCA hasn't done anything.
[AGENT][NEUTRAL] It's still loading.
[AGENT][NEUTRAL] So we've received this claim form.
[AGENT][NEUTRAL] that we have received.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Was for data service 12:18 and this is gonna be.
[AGENT][NEUTRAL] Kendall Anesthesia Associates, that is part of Baptist. The service facility was Baptist Hospital, but the billing provider is the Kendall Anesthesia Associates.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] And then that was the one received on the [PII]. Um, give me just one moment and I can look at the one that we received on yes I'm sorry, today actually.
[CUSTOMER][NEUTRAL] Yeah, I
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you for your patience, Mr. [PII]. This is opening.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and this one that we received.
[AGENT][NEUTRAL] It appears to be the, well, let me double check something. Um, it appears that we received the same thing twice. Just one moment.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So yes, it appears to be the same thing.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Was received twice. Yes, ma'am. So,
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Yeah, I'm gonna, I have, I'm gonna submit the HCA invoice maybe, uh, because I see codes in that because they wanted an invoice with codes.
[AGENT][NEUTRAL] Yes, ma'am. We will have to have the diagnosis codes and procedure codes for your dates of service along with the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Which I already sent that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You guys have, yeah, you guys have that, OK.
[AGENT][NEUTRAL] What date of service was that for?
[CUSTOMER][NEUTRAL] That was uh for let's see, December, I think it was October.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] The claim is still open.
[CUSTOMER][NEUTRAL] The claim is open.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] So when you do get the requested information that we were in need of, yes ma'am you can just upload that directly into your portal.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] But yeah, that's what I'm gonna do. OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, is there anything else that I could help you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That's it. Thank you. I greatly appreciate it.
[AGENT][POSITIVE] Well, you are certainly very welcome. It was my pleasure and thank you again for calling APL. I hope you have a wonderful weekend.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Yes ma'am. Thank you.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.