AccountId: 011433970860
ContactId: c48017c5-6c5b-49b7-be2f-56924a97cb7f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 430760 ms
Total Talk Time (AGENT): 204466 ms
Total Talk Time (CUSTOMER): 145082 ms
Interruptions: 3
Overall Sentiment: AGENT=1.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/c48017c5-6c5b-49b7-be2f-56924a97cb7f_20250429T13:25_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. How are you?
[AGENT][POSITIVE] I'm good, [PII]. How are you today?
[CUSTOMER][NEUTRAL] I'm doing OK. I am calling on behalf of Calcau Urgent Care, and I have a patient where it shows that we are billing American, um, basically APLI as secondary, and I need to get updated information on a claim status because I'm not sure. I know a lot of your policies y'all are a hospital indemnity plan.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the patient has a primary, but I just need to verify if you all received this claim and see how it processed.
[AGENT][NEUTRAL] OK, so you're needing to check claim status for member error code, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes ma'am, I can help you with that and what is a good call back number for you please?
[CUSTOMER][NEUTRAL] Car back number is [PII].
[AGENT][NEUTRAL] Thank you. And what is the member's policy number, please?
[CUSTOMER][NEUTRAL] I have 02442022.
[AGENT][NEUTRAL] Thank you. One moment while I get to my.
[CUSTOMER][NEUTRAL] And I apologize again. What is your name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Got it. OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII] would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] This is for [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] What's the date of service and total bill amount for her place?
[CUSTOMER][NEUTRAL] Um, this is gonna be for 11225. The total charge of the claim was $498.04.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And again you did say it was [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It looks like we billing secondary.
[AGENT][NEUTRAL] Yes, cause we are not a major medical.
[AGENT][NEUTRAL] And this is a limited benefit plan. Mhm. We're not a major carrier.
[CUSTOMER][NEUTRAL] OK, this is
[CUSTOMER][NEUTRAL] Is it, is it
[CUSTOMER][NEUTRAL] OK. Is it a hospital indemnity plan?
[AGENT][NEUTRAL] This one is. Mhm. Yes, ma'am, it is. And the claim, uh,
[CUSTOMER][NEUTRAL] Do they have
[CUSTOMER][NEUTRAL] Go ahead, I'm sorry.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, go ahead with your question.
[CUSTOMER][NEUTRAL] I was just gonna ask, do they cover a certain amount, because I think this plan only covers about $25 max.
[AGENT][NEUTRAL] Mm, let me look. What's the name of the facility, the urgent care again?
[CUSTOMER][NEUTRAL] Yes, um, it's Calcau, CAL.
[AGENT][NEUTRAL] What's the name, ma'am? OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It is [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a second here.
[AGENT][NEUTRAL] OK, so I do show that on this claim.
[AGENT][NEUTRAL] The benefit paid was $25.
[AGENT][NEUTRAL] The claim number that this was on Erica is 35599887.
[AGENT][NEUTRAL] The check that that benefit has been issued on if you need that, is a single check and it's 202-6195.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] And that check has cleared.
[CUSTOMER][NEUTRAL] OK. What can you tell me, um,
[CUSTOMER][NEUTRAL] I think I found it. OK, you said 2026195. What date did it pay on?
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] The same date, you mean the issue date? You want an issue date?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It's the same date as the process date. 2, I'm sorry, [PII].
[CUSTOMER][NEUTRAL] Got it. OK. So they, so they do have the same thing. It's an indemnity $25 max benefit. Got it.
[AGENT][NEUTRAL] For, for this, yes. And the other codes, let's see, were denied because the maximum benefit payable for this of service has been met. All of these hospital indemnity plans, just for your knowledge, [PII], are different.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] With different benefits. So it's, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I kinda figured that that's why I said let me call on it.
[AGENT][NEUTRAL] Correct. It will just depend upon the specific selection for that and for that group, you know, what they chose.
[AGENT][NEUTRAL] So I can't say that all of them are $25 cause they're not, but on this one, yes, that would be the maximum benefit, and that was paid.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, I don't know if anyone's oh, go ahead with what you were asking.
[CUSTOMER][NEUTRAL] Got it. Intra City.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] I was just gonna say I don't know if you've ever been.
[CUSTOMER][NEUTRAL] I was gonna ask you y'all give reference numbers.
[AGENT][NEUTRAL] Yeah, my name and today's date.
[AGENT][NEUTRAL] And then I don't know if anyone's ever given you this before, but we do have a portal [PII], that now that you have the claim number you should be able to have access to the EOB.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And our portal website? Oh, OK.
[CUSTOMER][NEUTRAL] I have the EOB.
[CUSTOMER][NEGATIVE] I was just trying to make sure I verified the benefit because one of them says $75 and then another one, it, it was conflicting information that I wanted to get confirmation on it.
[AGENT][NEUTRAL] It would just be depending on the type of service, so there's $75 must be for a different data service because that wouldn't have been for this claim.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, so it's gonna be depending on what services were rendered as to what the benefit amount would be if covered.
[CUSTOMER][POSITIVE] Got it. OK. All right.
[CUSTOMER][POSITIVE] Got it. OK. Thank you so much for your help. I appreciate it.
[AGENT][POSITIVE] Well, you are certainly very welcome. And is there anything else I can help you, help you about, help you with this morning, [PII]?
[CUSTOMER][NEUTRAL] No, that's
[AGENT][NEUTRAL] Oh, maybe I need more coffee.
[CUSTOMER][POSITIVE] No, that's it. Thank you so much.
[AGENT][POSITIVE] OK. Well, thank you for calling APL and I hope that you have a wonderful day.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][POSITIVE] Same to you love. You have a good one. Bye-bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Mm.