AccountId: 011433970860
ContactId: b934c34c-122a-4b2e-a241-6a832f0b9227
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 679000 ms
Total Talk Time (AGENT): 188244 ms
Total Talk Time (CUSTOMER): 211033 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/b934c34c-122a-4b2e-a241-6a832f0b9227_20250117T18:01_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from Mobile County to check on the status of a payment. Please be informed that this call has been recorded and monitored for quality and training purposes. And could you please spell your name for me?
[AGENT][NEUTRAL] Sure. That's [PII]. Last initial is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And Ms. [PII], may I have a callback number just in case we get disconnected? You're welcome.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] [PII], it's a direct line extension.
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, that is uh 01990400.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. What's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Day of services, uh.
[CUSTOMER][NEUTRAL] [PII] with the bill amount of $223.85.
[AGENT][NEUTRAL] OK, so that's [PII] of 24, correct?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me see if I can find this claim for you.
[AGENT][NEUTRAL] And for future you can check claim status online through our website at [PII] and that's just optional.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And let me pull the EOB one moment.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Can you verify some um procedure codes for me?
[CUSTOMER][NEUTRAL] Yeah, sure. That's so 36415.
[CUSTOMER][NEUTRAL] 83
[CUSTOMER][NEUTRAL] 058102599214.
[AGENT][NEUTRAL] So that's not
[CUSTOMER][NEUTRAL] It was
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] All right. Looks like we processed the claim [PII].
[AGENT][NEUTRAL] And we send a benefit amount of $150 to the provider.
[CUSTOMER][NEUTRAL] All right. My question is, may I know how was the claim process? It processed as primary or secondary for this member?
[AGENT][NEUTRAL] This is a limited hospital indemnity plan.
[AGENT][NEUTRAL] So it's not a primary or secondary, it's an indemnity plan. It's a limited plan.
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] Sorry it's.
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] This is a hospital indemnity plan. It's a limited plan. So they can, sometimes they use it as a primary, sometimes they use it as a secondary. It's not a major medical nor a secondary. It's an, it's a limited indemnity plan.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So you see is there any other insurance on the file for this member?
[AGENT][NEUTRAL] None that we can see.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Alright, one moment.
[AGENT][NEUTRAL] We don't coordinate. Mhm.
[CUSTOMER][NEUTRAL] So you, you don't coordinate with any other insurance, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Alright, and uh may I know the plan's original effective and termination date.
[AGENT][NEUTRAL] Mhm. Sure.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, it was effective on the [PII] and it is active at the moment.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you so much. And may I know is there any lapse in this policy? Is there any breaks in coverages in this policy?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The history, do you mind holding for me?
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for Miss [PII]. I don't see any for that period.
[CUSTOMER][POSITIVE] Thank you so much. And uh may I know when was the last time the coordination of benefits updated?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] We don't coordinate benefits.
[CUSTOMER][NEUTRAL] So there's no policy updated, right?
[AGENT][NEUTRAL] No. This is just a limited policy.
[CUSTOMER][POSITIVE] Thank you so much. And uh may I know the refund mailing address for my documentation purposes?
[AGENT][NEUTRAL] The address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] For this 1 may I know the call reference number?
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's date.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you so much. I do have one claim with the same number, same provider, so can I use the same information to that one too?
[AGENT][NEUTRAL] I'm sorry, can you repeat?
[CUSTOMER][NEUTRAL] I do have one another claim with the same number, same provider, but different date of service. So can I use the same information to that one?
[AGENT][NEUTRAL] Oh yes.
[AGENT][NEUTRAL] Um, you can, but it may be a different claim. Um, do you need me to check on that one?
[CUSTOMER][NEUTRAL] Yeah, it's the same number, same provider, but different date of service.
[AGENT][NEUTRAL] OK, what's the date of service?
[CUSTOMER][NEUTRAL] That is uh [PII].
[AGENT][NEUTRAL] OK, so this one also pay 150 and it's the same thing, yes. Uh-huh. The only difference is the claim number.
[CUSTOMER][NEUTRAL] So all the information is the same, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Call reference would be the same or different?
[AGENT][NEUTRAL] It's the same.
[CUSTOMER][POSITIVE] Thank you so so much. So I do want to claim with uh different member, different provider. So could you please help me with that one?
[AGENT][NEUTRAL] OK bear with me, let me make a note on this one and you don't need any other information on this one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] you
[AGENT][NEUTRAL] OK, what's the next policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] The.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you for staying connected. I appreciate your patience. So the next number ID is D as in Delta 43,731,210.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK, do you see a policy certificate number? It's gonna start with a 0 followed by 7 digits like the previous one.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I you
[AGENT][NEUTRAL] Yeah, um, what inform
[CUSTOMER][NEUTRAL] So for this one we don't have any.
[AGENT][NEUTRAL] That the number is not for us. Um, do you have like the social so I can try to pull the number or you want me to do a name search?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] No, sir, that's all for today. Thank you for your assistance. Have a great day.
[AGENT][POSITIVE] You as well and thank you for calling APL mhm bye bye.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Mm bye.