AccountId: 011433970860
ContactId: c5926b5e-4463-4d79-95c4-29fcf96697e7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 271190 ms
Total Talk Time (AGENT): 122882 ms
Total Talk Time (CUSTOMER): 96918 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/c5926b5e-4463-4d79-95c4-29fcf96697e7_20250116T19:14_UTC.wav
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[AGENT][POSITIVE] Afternoon, thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. I'm calling about a recent claim that I filed. Um, I was wondering why the, the claim was not paid when other claims for the hospital stay were paid.
[AGENT][POSITIVE] Well, it would be my pleasure to assist you. Do you have your policy number available?
[CUSTOMER][NEUTRAL] I do, but I'm not sure if I this might be the old policy because I only got the card for the first year, but it's 021-92190.
[AGENT][NEUTRAL] All right, thank you. And do you mind verifying your name and date of birth?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And your name and mailing address?
[CUSTOMER][NEUTRAL] Oh sorry, [PII], [PII].
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] All right, thank you. And what about your email and phone number?
[CUSTOMER][NEUTRAL] [PII] and [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And what was the date of service?
[CUSTOMER][NEUTRAL] OK, so it looks like um.
[CUSTOMER][NEUTRAL] The data service was [PII].
[CUSTOMER][NEUTRAL] And I
[CUSTOMER][NEUTRAL] There was a co-pay of $150 in co-insurance of $506.40.
[CUSTOMER][NEUTRAL] Um, the only $34 or around $30 was paid out on the claim.
[AGENT][NEUTRAL] OK. Was that for Baptist Medical Center? No, that was in 22. Hang on just a second.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] It might be.
[CUSTOMER][NEUTRAL] There might be a new policy number 423.
[AGENT][POSITIVE] Yeah, I've got it pulled up.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm sorry, it just, I was looking at the wrong thing, but I've got your, the policy that was active from 5123 to 5124.
[CUSTOMER][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I do have that policy pulled up.
[AGENT][NEUTRAL] And let me just get all these claims pulled up for that date of service at 4:15.
[AGENT][NEUTRAL] And that was 2023, I mean [PII].
[CUSTOMER][NEUTRAL] 4, yes, ma'am.
[AGENT][POSITIVE] Got you. Thank you. I appreciate it.
[CUSTOMER][POSITIVE] No worries.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] It was 4, was it 4:15 to 4:18?
[CUSTOMER][NEUTRAL] Uh yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Now I see a claim for Florida Women Care that we paid $884 on.
[CUSTOMER][NEUTRAL] Correct, this was for the actual hospital.
[CUSTOMER][NEUTRAL] That was for the OB I guess.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then for Baptist South we paid for data service 415 to 418 we paid $35.65.
[CUSTOMER][NEUTRAL] Yes, why isn't the copay and co-insurance covered on that?
[AGENT][NEUTRAL] And that
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So actually that.
[AGENT][NEUTRAL] Benefit maxed, we did not have the complete amount remaining to cover that deductible copay or co-insurance for that claim.
[AGENT][NEUTRAL] All we had remaining by the time we received the hospital claim was $35.65.
[AGENT][NEUTRAL] Your inpatient hospital benefit was $3000 for the calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so it hit the max is why we only received that 34.
[AGENT][POSITIVE] That's right.
[CUSTOMER][MIXED] OK, but everything else is covered.
[AGENT][NEUTRAL] Yes, ma'am, it looks like.
[CUSTOMER][NEUTRAL] Before that, I see. So it would have been, it would have been covered had the Mac not been hit.
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] We would have, we would have been able to pay that.
[CUSTOMER][POSITIVE] OK perfect thank you.
[CUSTOMER][NEUTRAL] That was my only question.
[AGENT][POSITIVE] Well, it's been a pleasure to assist you and Ms. [PII], if you need anything else, don't hesitate to give us a call and I hope you have a wonderful afternoon.
[CUSTOMER][POSITIVE] You too thank you so much goodbye.
[AGENT][POSITIVE] Thank, thank you. Bye-bye.