AccountId: 011433970860
ContactId: d850ac7c-1a3d-4e16-9208-34b873eb022e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 419910 ms
Total Talk Time (AGENT): 249488 ms
Total Talk Time (CUSTOMER): 130048 ms
Interruptions: 1
Overall Sentiment: AGENT=1.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/d850ac7c-1a3d-4e16-9208-34b873eb022e_20250110T21:42_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] and I'm calling to check status of two claims.
[AGENT][POSITIVE] OK, yeah, I'd love to help you with some claim status today. And did you say it was [PII]? Did I hear that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, [PII]
[AGENT][POSITIVE] Wonderful. Thank you so much, Ms. [PII]. And do you mind if I grab a good callback number real quick?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Perfect, thank you. And may I have the policy number, please?
[CUSTOMER][NEUTRAL] Sure, D as in David 43731679.
[AGENT][NEUTRAL] Hi, hey, Ms. [PII], so that policy number is going to be for the 90 degree benefits and IMA. Ours would be like 6 to 8 digits and it wouldn't start with any letters.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, wait, so I, I, I, maybe they put the wrong because they got that policy number and I looked for an insurance card. I didn't see one and this is a contact number that they have for me to call. So you said this is a 90 degree policy?
[AGENT][NEUTRAL] Yeah, and sometimes they have both um benefits with us and benefits with them. Do you want me to try searching for your insured with their first and last name?
[CUSTOMER][NEUTRAL] Sure, please.
[AGENT][POSITIVE] OK, perfect. And then if you wouldn't mind spelling them for me.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] OK. [PII], uh the first name, [PII] The last name is [PII]
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] You said [PII], right at the end?
[CUSTOMER][NEUTRAL] Oh right, [PII].
[AGENT][NEUTRAL] And would you be able to let me know what city and state your insured is calling out of?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] [PII], OK. And, uh, [PII]'s date of birth for me?
[CUSTOMER][NEUTRAL] Well, I'm calling, my office is in, my office is in [PII], but he's from [PII].
[AGENT][NEUTRAL] That's
[AGENT][POSITIVE] Perfect. he was the only one I had in [PII], so I think this is gonna narrow him down, but if you could confirm his date of birth for me.
[CUSTOMER][NEUTRAL] Right, OK.
[CUSTOMER][NEUTRAL] The date of birth is [PII].
[AGENT][NEUTRAL] All right, then this is him and let me pull up that policy, and it does look like he has benefits with both us and I need degree benefits. So let me see if I have any claims on file. What's the date of service?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The date of service, the first one is [PII] of [PII].
[AGENT][NEUTRAL] Alright, and the total bill amount?
[CUSTOMER][NEUTRAL] Total bill amount on this one is $9,221.02.
[AGENT][NEUTRAL] Alright, and I do see that one. Give me one second. And I'm so sorry, do you want me to give you his policy number as well?
[CUSTOMER][NEUTRAL] Sure, please.
[AGENT][NEUTRAL] I have his policy number listed as 2540017.
[CUSTOMER][NEUTRAL] 254-0017
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it looks like if you could just verify for me the name of the facility on file for this claim.
[CUSTOMER][NEUTRAL] Piedmont Augusta Hospital.
[AGENT][POSITIVE] Wonderful. OK. So it looks like we received this claim [PII] and we processed it [PII].
[AGENT][NEUTRAL] Um, it looks like your claim number is 34, so sorry, I cannot talk. 3544.
[AGENT][NEUTRAL] Ma'am, can I start over?
[CUSTOMER][NEUTRAL] You can.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's right. It's the end of the day and it's Friday.
[AGENT][NEUTRAL] I
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And so I understand.
[AGENT][NEUTRAL] I have 354-849-3.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this did have benefits payable um by check of $100.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] It looks like.
[AGENT][NEUTRAL] The check number is 2021675, and I do have these notes on here saying
[AGENT][NEUTRAL] Um, that with the payment of this check, the maximum benefit payable for the state of service has been met, so the maximum benefit for that date of service has been met, but then it does state here as far as um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I can tell you the code in one second, but I don't remember it now that I've clicked out. Um, it says the outpatient rider only allows payment for outpatient surgery in an outpatient hospital or physician office. Therefore, no benefits are payable, um, and then it tells them to refer to section 5 of their policy with any concerns.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, well, I'll let the, whoever post that and have to whenever they post the payment, they can work the, the denial part of it.
[AGENT][NEUTRAL] Yeah, and then that check, um, I do want to let you know, it looks like if they made it went out in the mail on the [PII], so you should be seeing it in a couple of days, um, but they put it in the mail on the morning of the [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, well that sounds good and I do have another data service for him. Let's see if he have that one also, let me see what that data service is.
[AGENT][NEUTRAL] OK, yeah, let me take a look. What's that data service?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, and then for.
[CUSTOMER][NEUTRAL] Oh, the total amount $700.
[AGENT][NEUTRAL] For that one, it looks like I do have hang tight.
[AGENT][NEUTRAL] Alright, so for that one on the [PII].
[AGENT][NEUTRAL] Of [PII], it looks like.
[AGENT][NEUTRAL] That one is pending still, so that claim has not been processed, but it has been received, um, and it is still working.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, how much time should I allow to for the um processing?
[AGENT][NEUTRAL] You betcha. So with this one, we're just waiting on information um from outside of us, and so you might give us just a little bit longer. I'd recommend 7 to 10 more days.
[CUSTOMER][NEUTRAL] OK, alright, and uh do you have a claim number?
[AGENT][NEUTRAL] Oh, yes, I can at least give you the claim number. It is 354-8491.
[CUSTOMER][NEUTRAL] OK, and is there a reference for both of the calls reference number?
[AGENT][NEUTRAL] Yeah, it's going to be just my name [PII], and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's all I need then.
[AGENT][POSITIVE] All right, thank you so much, Ms. [PII]. I really appreciate your patience.
[CUSTOMER][POSITIVE] OK, thank you. Have a good weekend.
[AGENT][POSITIVE] My pleasure. You too. Bye-bye.
[CUSTOMER][NEUTRAL] Alright bye bye.