AccountId: 011433970860
ContactId: d2a13d39-67d7-45b3-babf-f7bd8dd3a643
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 313920 ms
Total Talk Time (AGENT): 119256 ms
Total Talk Time (CUSTOMER): 113758 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/d2a13d39-67d7-45b3-babf-f7bd8dd3a643_20250224T14:41_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, so, good morning. My name is [PII] and I'm calling from Deaconess Henderson Hospital. I need help with a member's claim.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, sure, I can assist you with claiming this, [PII], and may I have a call back number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, that would be [PII] and that's the direct line.
[AGENT][NEUTRAL] Thank you and may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Sure, that's 02580546.
[AGENT][NEUTRAL] Thank you. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Perfect, thank you. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII] uh looks like total bill amount was $7,883.50.
[AGENT][NEUTRAL] OK, thank you. Alright, let me see if I have that claim.
[CUSTOMER][NEUTRAL] I do have a claim number if that helps.
[AGENT][NEUTRAL] OK, what's that number?
[CUSTOMER][NEUTRAL] 355.
[CUSTOMER][NEUTRAL] 8229.
[AGENT][NEUTRAL] OK, one moment, let me put in.
[AGENT][NEUTRAL] I'm waiting on the AOB to pull up, OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK. Well, I'll wait for that. I see that um this member has one of our hospital indemnity plan which is a limited plan um and it looks like um based on the explanation of benefits for uh that date of service, the calendar year maximum for diagnostic service has been met.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I did look at the patient's chart and uh it appears that they haven't been at least with the Deaconess uh facility in quite some time. It looks like their last day of service was [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can you provide maybe a data service that they might have used their benefits?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's not gonna be for the same provider and maybe a different provider that submitted a claim for them because this is for any diagnostic testing during the year for any type of um providers that send in the claim um I can check and make sure they use that benefit, but I cannot really any information that is not pertaining to your claim. Mhm yeah, sure.
[CUSTOMER][NEUTRAL] Yeah, would you? Oh, sure, that, that's fine. Yeah, if you could just verify that because like I said, a deacon is a patient lives in [PII] and you know Deaconess Hospital is the only hospital here, so.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just verify
[AGENT][NEUTRAL] Mm OK.
[AGENT][NEUTRAL] Yeah, I see that it was paid out, but yeah, it's, it's, it's not for again so I cannot release the information.
[CUSTOMER][NEUTRAL] That's fine, but you have verified that yes, the benefit was correctly maxed out, um, and the, the it processed per plan, correct? So my next question is um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct. Mhm. Yes.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Then for this state of service, is this all patient responsibility, I mean the bill amount of $7,883?
[AGENT][NEUTRAL] It's gonna be up to the provider's discretion because we don't have any contractual involvement. The reason for that is because this is just a limited policy. Um, it is not a major medical. We don't know if they have any other policies out there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. And then if you could provide a call reference.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will. Do you need the spelling of my name or any other information?
[CUSTOMER][NEUTRAL] Please, yes. Yeah, if you provide the spelling of your name.
[AGENT][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] Sure, no problem. That's it, [PII]. That's [PII]. Last initial [PII].
[CUSTOMER][POSITIVE] Perfect. All right. Well, thank you so much. You have a good day and a good week ahead.
[AGENT][POSITIVE] You're welcome. You as well. Thank you for calling APL. Miss [PII].
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Right