AccountId: 011433970860
ContactId: deec3958-f4ef-4a4d-9ce7-5fec6057846b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 603880 ms
Total Talk Time (AGENT): 169834 ms
Total Talk Time (CUSTOMER): 138212 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/deec3958-f4ef-4a4d-9ce7-5fec6057846b_20250530T12:45_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good morning, [PII]. My name is [PII] and I'm calling from WakeMed Specialist Group.
[CUSTOMER][NEUTRAL] And I'm calling to see if I can get status of a few outstanding claims please.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim statuses. And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, ma'am. It is [PII] [PII].
[AGENT][NEUTRAL] Thank you for that. And are they multiple members or different data service for a member?
[CUSTOMER][NEUTRAL] Different dates of service for a member.
[AGENT][NEUTRAL] OK, and may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes ma'am, it is 2586425.
[AGENT][NEUTRAL] I'm sorry, I was typing and it did not type. Can you repeat that for me, please? I'm sorry.
[CUSTOMER][NEUTRAL] No problem, 2586425.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And um may I have the dates of service and the total bill? You can give them all to me at once if you like.
[CUSTOMER][NEUTRAL] OK, bear with me one minute and let me get there.
[CUSTOMER][NEUTRAL] OK, so I have [PII].
[CUSTOMER][NEUTRAL] For $336.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Of
[AGENT][NEUTRAL] Hold on, is this a 24 or 25?
[CUSTOMER][NEUTRAL] 25.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 25, I'm sorry.
[AGENT][NEUTRAL] It's OK. And what was the first amount?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] $336.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have [PII].
[CUSTOMER][NEUTRAL] For $290?
[CUSTOMER][NEUTRAL] Give me one moment because I gotta go to a different screen.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Oh, take your time.
[CUSTOMER][NEUTRAL] They're sitting in two different categories. Give me one second.
[CUSTOMER][NEUTRAL] And then I have
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] For 249.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] For 156.
[CUSTOMER][NEUTRAL] And then [PII] again for 391.
[AGENT][NEUTRAL] Alright, and is it OK if I place you on just a brief hold while I go through the claims?
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] 336.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. All right, so I have all the claims here. Um, so I'll start with the first one, [PII] for $336. Um, so we received.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One second, let me find it. 1 2nd. So like I said, it's in two places, so I gotta make sure I document.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] at [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it. OK, go ahead.
[AGENT][NEUTRAL] OK. Uh, so we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 3359.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] 7072.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Because the policy covers treatment by a physician.
[AGENT][NEUTRAL] For a covered sickness in a physician's office clinic.
[AGENT][NEUTRAL] Urgent care
[AGENT][NEUTRAL] Or emergency room?
[AGENT][NEUTRAL] So according to the claim, it wasn't a covered place of service.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] So it's patient responsibility.
[AGENT][NEUTRAL] Um, so for all of these, we don't determine patient responsibility because we're not a major medical insurance company.
[CUSTOMER][NEUTRAL] What I'm saying, is it an adjustment or is it a major medical? I mean, or is it a patient responsibility or is it our discussion?
[AGENT][NEUTRAL] Right, I understand the question, but because of the type of company we are, we're not a major medical insurance company, so we don't determine patient responsibility for medical, only dental. So that would be whatever your procedures are for outstanding balances, write off bill, we just can't tell you what to do.
[CUSTOMER][NEUTRAL] So this is a digital plan?
[AGENT][NEUTRAL] This is a hospital indemnity policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, perfect. um I guess the other ones if you'll just give me the claim number because they're all gonna fall under the same issue.
[AGENT][NEUTRAL] OK, um, so for [PII], 2025, 290.
[AGENT][NEUTRAL] The claim number is 359.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] 7078.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] For [PII], 249.
[AGENT][NEUTRAL] The claim number is 360.
[AGENT][NEUTRAL] 4068.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] For [PII], $156.
[AGENT][NEUTRAL] That claim number is 360.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] 4071.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And for [PII], 391?
[AGENT][NEUTRAL] That claim number is 360.
[AGENT][NEUTRAL] 4069.
[CUSTOMER][POSITIVE] Perfect. Is there a call reference number for this for this?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name and today's date and the first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you so much, [PII]. You have a wonderful day.
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, ma'am. You have been wonderful. You have a wonderful day.
[AGENT][POSITIVE] Alright. You also, thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Uh-huh, bye-bye