AccountId: 011433970860
ContactId: d7667d13-fef3-44c5-9e0c-0213b4d08490
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 328649 ms
Total Talk Time (AGENT): 125854 ms
Total Talk Time (CUSTOMER): 93567 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/d7667d13-fef3-44c5-9e0c-0213b4d08490_20250424T18:06_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII] and I am calling from um Multi-care Health Systems regarding claim processing.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How do you spell your name, [PII]?
[AGENT][NEUTRAL] Um, [PII].
[CUSTOMER][POSITIVE] Perfect thank you.
[AGENT][NEUTRAL] You're welcome. May I have the spelling of your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And may I have a callback number just in case we get disconnected.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] I have.
[CUSTOMER][NEUTRAL] 025650007
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] OK, perfect. Thank you. All right. And do you have a date of service for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] How much is the total charge of the claim?
[CUSTOMER][NEUTRAL] Oh and.
[CUSTOMER][NEUTRAL] $3,141.60.
[AGENT][NEUTRAL] All right. Thank you. Let me see if I can find this claim. That was uh [PII].
[AGENT][NEUTRAL] And for the future, you can check claim status online through our website at [PII] and that's just optional and bear with me, let me pull this EOB for you, OK? One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] You're waiting on the system. I'm sorry.
[CUSTOMER][POSITIVE] You're OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so it looks like we processed this claim on [PII] and we send a benefit amount of $50 to the provider.
[AGENT][NEUTRAL] And that is the maximum.
[CUSTOMER][NEUTRAL] Right, but what did you allow on the claim?
[AGENT][NEUTRAL] Uh, this particular policy is a limited hospital indemnity plan. It's not a major medical. So it just has like a flat amount that we cover, and that flat amount is $50.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] I see we have two payments from you guys on this claim. One is the $50 and then we have another payment for $250. So but that one looks like it has a different policy number. It's the same numbers I gave you, but it ends in 808 instead of 07. So does he have like two policies?
[AGENT][NEUTRAL] OK, let me see if.
[AGENT][NEUTRAL] Maybe I can check and see.
[AGENT][NEUTRAL] So it ends in 08. You're welcome. OK, so, yeah, he has an accident policy that ends in 08. So if it was related to an accident, we did part uh pay that accident part of it, which is the 250.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK, so basically this is a hospital claim and this is not even paying up to Medicare allowable, so it's only $300 right? So can we bill the patient the remaining balance?
[AGENT][NEUTRAL] Um, it's up to the provider's discretion. We don't have any contractual involvement on the remaining, uh, and we don't know if he has any other policies out there, any major medicals or anything like that, but this is all a limited policy.
[CUSTOMER][NEUTRAL] OK, can I get a reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you would like.
[CUSTOMER][POSITIVE] OK perfect thank you.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day, Ms. [PII].
[CUSTOMER][NEUTRAL] Bye bye.