AccountId: 011433970860
ContactId: bb5da5dd-e2c9-4340-80af-e9a90a161f81
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 378980 ms
Total Talk Time (AGENT): 179954 ms
Total Talk Time (CUSTOMER): 83061 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/bb5da5dd-e2c9-4340-80af-e9a90a161f81_20250502T17:59_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], I'm just calling in to uh verify why the claim has been underpaid.
[AGENT][NEUTRAL] Hey, you're wanting to verify why a claim was under what you feel is underpaid, is that correct?
[CUSTOMER][NEGATIVE] Yeah, we were expecting more than what was paid.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I can help you with this and looking at the claim. And are you calling from the provider's office?
[CUSTOMER][NEUTRAL] I am from Bruton Methodist Hospital.
[AGENT][NEUTRAL] OK, yes, sir, I can help you and who am I speaking with?
[CUSTOMER][NEUTRAL] Uh, my name is [PII]. What's your name again? I'm so sorry.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] You're welcome. And [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] Yes, ma'am. Uh that's gonna be 02474910.
[AGENT][POSITIVE] OK, thank you. Give me a couple of moments today to get all of the members' information pulled up please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that any information that is provided today would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Uh, patient's name is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What is the data service day and total bill amount please?
[CUSTOMER][NEUTRAL] Um, yes, date of service [PII] bill amount $227.07.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And do you already have the claim number you said?
[CUSTOMER][POSITIVE] I do, yes.
[AGENT][NEUTRAL] OK, and what is the claim number you have?
[CUSTOMER][NEUTRAL] Um, that is 353-644-6.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I do see that there was.
[AGENT][NEUTRAL] A benefit paid in the amount of $175.
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] Mm, based on the explanation of benefits we received, uh, we only receive a payment of $144.31.
[AGENT][NEGATIVE] Oh no.
[AGENT][NEUTRAL] OK, let me pull this information up because I'm once I'm seeing different information on a couple of years. Hold on one second.
[AGENT][NEUTRAL] OK, you are correct. I'm sorry, I was looking at another screen. OK, so just one moment, that is the bill amount that was paid and give me a moment to get the remarks.
[CUSTOMER][NEUTRAL] That's fine.
[AGENT][NEUTRAL] OK, so on the, the wellness portion of it.
[AGENT][NEUTRAL] In which?
[AGENT][NEUTRAL] And I'm sorry about kind of delayed in what I'm telling you it's because I'm having to look in multiple locations here.
[AGENT][NEUTRAL] So for code 80053.
[AGENT][NEUTRAL] With that benefit amount of $25 that was paid on that, the calendar year maximum for this benefit has been exhausted with the payment of this claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For the 80053.
[AGENT][NEUTRAL] Yes sir, because I show the charge was 3840, we paid $25 towards that.
[AGENT][NEUTRAL] And with that payment, that max the benefit was maxed for this calendar for the calendar year.
[CUSTOMER][NEUTRAL] So, um, because I don't see any patient responsibility on this, um, claim.
[AGENT][NEUTRAL] That is correct. This is not major medical, right. This is not major medical insurance that it's a hospital indemnity limited benefit plan. So APL does not determine patient responsibility, that would be up to the provider.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] And you, and.
[CUSTOMER][NEUTRAL] OK, I understand. Uh, what is the reference number for, sorry?
[AGENT][NEUTRAL] Oh, I'm so sorry. My, you would use my name along with today's date as your call reference number, and they, do you have the explanation of benefits with those remarks on it?
[CUSTOMER][POSITIVE] I do, yes.
[AGENT][NEUTRAL] OK, alright, so in the future if for any reason you do not have an explanation of benefits for one of our policy holders you you should be able to locate that and print it by going to our portal at [PII].
[CUSTOMER][POSITIVE] All right. All right. Thank you, [PII] for your help. That's all for me.
[AGENT][POSITIVE] Well, you're welcome. OK, well, if that's all I can help you with, thank you again for calling APL [PII] and I hope you have a wonderful weekend. Yes, sir. You're welcome.
[CUSTOMER][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEUTRAL] You too bye bye bye bye.
[AGENT][POSITIVE] Thanks. Bye-bye.