AccountId: 011433970860
ContactId: d7f36c41-6537-4cbf-a9cc-292499651f3f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 365010 ms
Total Talk Time (AGENT): 160556 ms
Total Talk Time (CUSTOMER): 132683 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/d7f36c41-6537-4cbf-a9cc-292499651f3f_20250501T12:35_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Yes, I have a question about a bill I incurred from a surgery I had last July.
[AGENT][POSITIVE] OK, I'll be glad to help you. Go ahead and give me your name and your policy number, please, sir.
[CUSTOMER][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] And the policy number is uh.
[CUSTOMER][NEUTRAL] Of the group number? OK, the benefit certificate number 0130136975.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Oh that was 0136975. Is that correct, [PII]?
[CUSTOMER][NEUTRAL] Um, I actually, I'm sorry there's a.
[CUSTOMER][NEUTRAL] Different number that I have on my card. I have two different ones written on here. Um, the card that was issued [PII] says outpatient benefit certificate number 02516003.
[AGENT][NEUTRAL] OK, I'm gonna pull that one up.
[CUSTOMER][NEUTRAL] And then I have handwritten in a policy number.
[AGENT][NEUTRAL] I I think, uh, let's see, [PII].
[AGENT][NEUTRAL] Uh, my system is a little slow this morning, so bear with me please, sir, and while I'm pulling this up, go ahead and give me a good return telephone call number please sir, just in case we're having bad weather, just in case I lose you, I can call you back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you. [PII].
[AGENT][NEUTRAL] Alrighty, [PII], thank you for all that information. OK, the the 0251 number is coming up for you. So go ahead and verify your date of birth and your address for me.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[CUSTOMER][NEUTRAL] And the address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alrighty. Alrighty. Thank you so much for all that information, [PII]. OK, so you want to check status of a claim. Do you know the date of service, please, sir?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] OK, let's see, [PII].
[AGENT][NEUTRAL] Mm well I show this number didn't go into effect, so hang on just a second, [PII]. Let's see, this must be your new number. So hang on, let me do some checking.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have another policy number from an older card.
[AGENT][NEUTRAL] I'm gonna, let's see.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] I'm gonna pull up uh your name and find all of your policies here because yeah, it's not gonna be under that one, but give me just a moment. I'm doing some checking. OK, I see another number. Oh yes, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] It's the other number the [PII] number?
[AGENT][NEUTRAL] Yeah, so you have several numbers on our system. [PII]. OK, let me go to that number. That's it.
[CUSTOMER][NEUTRAL] Yes, OK.
[AGENT][NEUTRAL] OK, now that that service is 729-2024. Let me key that in. Let's see what we have. OK, I see a bunch of claims. OK, which one are you talking about then, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Let's see, it's uh the total bill is 1692.
[CUSTOMER][NEUTRAL] And there's an insurance adjustment for 288, so it says total due is 1404.00.
[AGENT][NEUTRAL] Yeah, looks looks like you have a per calendar day benefit here of $1000 so that per calendar day benefit was paid out to the facility, so your anesthesia bill for that $1692 is not gonna have any benefit available here at APL at all.
[CUSTOMER][NEGATIVE] OK, so because this, this is for the anesthesiologist, you've already paid the, the portion for the surgery. So since this is the same day, there's no coverage for what you're saying.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, sir, that's correct. You have that $1000 per calendar day benefit.
[AGENT][NEUTRAL] Yes, sir. So that has already been maxed out.
[CUSTOMER][NEUTRAL] OK, 1000 per day benefit and then um.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I guess that's right, I guess that explains it then. OK, uh.
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] Well, yes, sir. Is there anything else I can help answer for you today, [PII]?
[CUSTOMER][POSITIVE] No, I don't think so. Thank you very much for your help though.
[AGENT][POSITIVE] Oh, well, yes, sir, then and thanks so much for calling APM [PII]. You have a great rest of your day, OK?
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][POSITIVE] Thank you, sir. Bye bye.