AccountId: 011433970860
ContactId: f7cdd1a1-788b-4641-8014-1f71bf06a545
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 436829 ms
Total Talk Time (AGENT): 178002 ms
Total Talk Time (CUSTOMER): 146546 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/f7cdd1a1-788b-4641-8014-1f71bf06a545_20250414T18:31_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] with North Mississippi Medical Center. I'm trying to verify a policy.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] [PII], yes, I'm here.
[AGENT][POSITIVE] I don't know what just happened to my phone muted on its own. I'm sorry about that.
[CUSTOMER][NEUTRAL] I don't know what just happened in my phone muted on this.
[AGENT][NEUTRAL] Like I was just talking and then I was like, wait, you can't hear me?
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] I know, I could not hear you. I, and then I thought it was me. I was like, well, what happened?
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] It just, it, I don't know, I'm sorry about that, um, but you said you needed like for eligibility to like see if it's active, OK.
[CUSTOMER][POSITIVE] You're good.
[CUSTOMER][NEUTRAL] Yeah, I need to know, yeah, I need to know if this patient's eligible on this policy.
[AGENT][NEUTRAL] Sure, and may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] My name is [PII] I can be reached at [PII]. That's a direct line.
[AGENT][NEUTRAL] Thank you. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] My patient's ID number is 02584085.
[AGENT][NEUTRAL] 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] I have [PII], [PII].
[AGENT][POSITIVE] Alrighty, thank you so much for verifying his information and I am showing that the policy is active. It's been effective since [PII].
[CUSTOMER][POSITIVE] Alrighty thank you so much for there.
[CUSTOMER][NEUTRAL] OK, what type of policy is this?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] This is a hospital indemnity policy, um, so it's a limited medical benefit plan.
[CUSTOMER][NEUTRAL] Do you pay the patient directly?
[AGENT][NEUTRAL] Um, it could be.
[CUSTOMER][NEUTRAL] Or do you pay the provider?
[AGENT][NEUTRAL] It depends on what comes through. Um, it could be either or. So there's a list of covered, uh, services, and then, um, if it's not on this list, it wouldn't be covered, but most of the time it's to the provider. There are some times where we do pay to the patient.
[AGENT][NEUTRAL] Depending on what that.
[CUSTOMER][NEGATIVE] Well, I have an outstanding claim.
[CUSTOMER][NEUTRAL] For he has a claim that we submitted for [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] $358.
[AGENT][NEUTRAL] Let's see, hold on one moment.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 358. Hold on one moment, I'm just searching the claims.
[AGENT][NEUTRAL] OK, so I did locate a claim. Um, let me get the date. Hold on one moment. Everything is popping up.
[AGENT][NEUTRAL] Alright, so we received this claim on [PII]?
[AGENT][NEUTRAL] I'm sorry, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It processed on the [PII], [PII]. The claim number is 356.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 7362.
[AGENT][NEUTRAL] And the claim was denied. Let me see why.
[AGENT][NEUTRAL] Oh, treatment in an outpatient hospital less than 18 hours is not covered by this policy.
[CUSTOMER][NEUTRAL] Treatment?
[CUSTOMER][NEUTRAL] In a what outpatient hospital.
[AGENT][NEUTRAL] Mhm. Yes, ma'am. Less than 18 hours.
[CUSTOMER][NEUTRAL] For less than, OK.
[CUSTOMER][NEUTRAL] Not covered. Well, can I, can you email me a copy of the EOB?
[AGENT][NEUTRAL] I can't email it, but I can fax it to you.
[CUSTOMER][NEUTRAL] OK, please put it to my attention, um, [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My fax number.
[CUSTOMER][NEUTRAL] It's 662 area code.
[CUSTOMER][NEUTRAL] 377.
[CUSTOMER][NEUTRAL] 5475.
[AGENT][NEUTRAL] OK. Attention [PII], [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 547 5 and it's R.
[AGENT][NEUTRAL] [PII], OK.
[AGENT][POSITIVE] Sorry about that, and I will go ahead and fax this explanation of benefits over to you now. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] Thank you [PII].
[CUSTOMER][NEUTRAL] No, I'll make sure he don't have any more claims. Hold on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh oh, looks like he does have one more.
[CUSTOMER][NEUTRAL] How much was that? 13? OK, how about, well, this is really old, [PII].
[AGENT][NEUTRAL] With
[CUSTOMER][NEUTRAL] [PII] for $369.
[AGENT][NEUTRAL] 369.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The only one
[AGENT][NEUTRAL] Alright, so this one we received on [PII].
[CUSTOMER][NEUTRAL] Hold on, let me write that down here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm. And the claim number is 358.
[AGENT][NEUTRAL] 7907.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied um for the same reason.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can you send me that EOB as well?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, so this one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Alrighty, and I am sending them both to you now. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] No, I think we got it taken care of. I thank you.
[AGENT][POSITIVE] You're very welcome. Well thanks for calling APL and I hope you have a great day.
[CUSTOMER][NEUTRAL] Same to you, bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.