AccountId: 011433970860
ContactId: f947edc8-0703-4fde-a8af-918acf8c4b79
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 261119 ms
Total Talk Time (AGENT): 71696 ms
Total Talk Time (CUSTOMER): 130496 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/f947edc8-0703-4fde-a8af-918acf8c4b79_20250411T18:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes, definitely. Uh, my name is [PII]. I'm calling on behalf of Emory Saint Joseph's Hospital of Atlanta. I'm trying to see if I have the right place, looking for claim status.
[AGENT][NEUTRAL] OK, I can help you with claim status, [PII]. Do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Um, they have here 02468294.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Uh, last name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] What was that date of service?
[CUSTOMER][NEUTRAL] Data service, um, oh, data service was [PII].
[AGENT][NEUTRAL] And the bill charges?
[CUSTOMER][NEUTRAL] $5,769.23.
[AGENT][NEUTRAL] Uh, looks like we made a payment of 200.
[AGENT][NEUTRAL] That was on
[AGENT][NEUTRAL] 25, 25.
[CUSTOMER][NEUTRAL] Now that we now they did put down here expected reimbursement of $2,307.69.
[AGENT][NEUTRAL] Um, was this for imaging, is that correct?
[CUSTOMER][NEUTRAL] Which
[CUSTOMER][NEGATIVE] Um, well, that's expected reimbursement. That's what they put down here.
[CUSTOMER][NEUTRAL] So, um, is it possible for to go back and processing for underpayment? Is that possible?
[AGENT][NEUTRAL] Uh, let me pull up the policy and see. This is a limited hospital indemnity plan, so it's, it's a limited.
[CUSTOMER][NEUTRAL] Oh really? 00 boy, OK. Oh OK.
[AGENT][NEUTRAL] Yeah, so it's
[AGENT][NEUTRAL] It's, it's a limited plan.
[CUSTOMER][NEUTRAL] It looks doesn't look good here. OK, OK.
[CUSTOMER][NEUTRAL] Limited, OK, hm.
[AGENT][NEUTRAL] Yeah, so, so their benefit for diagnostic imaging is gonna be $200 per day.
[CUSTOMER][NEUTRAL] OK, it's living in indemnity. OK, $200 a day.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, and then one day per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, oh my goodness. So, so that, so that means that they, that's the maximum $200 is it.
[AGENT][NEUTRAL] Yeah, that's the max we pay under this policy, correct.
[CUSTOMER][NEGATIVE] Apparently the person didn't get that memo.
[AGENT][NEUTRAL] Yeah, um,
[CUSTOMER][NEUTRAL] But they didn't, they must not, they must not have known that because uh that's crazy. Wow. OK. So $200 is it. They, uh, so the rest of it is page responsibility then.
[AGENT][NEUTRAL] Uh, well, we don't determine patient responsibility as since this is a supplemental policy, yeah.
[CUSTOMER][NEUTRAL] Oh, you don't.
[CUSTOMER][NEUTRAL] OK, you don't, you don't. OK. All right. So I'll just, OK, I'll put it down as $200 a payment, OK, this is limited indemnity.
[CUSTOMER][NEUTRAL] Plan, OK.
[AGENT][NEUTRAL] A hospital indemnity, yeah, yeah.
[CUSTOMER][NEUTRAL] Hospital limited hospital indemnity plan.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, indemnity, do you have the claim number?
[AGENT][NEUTRAL] I do. It is 357-743-3.
[CUSTOMER][NEUTRAL] OK, that's the claim number. OK, so this was paid on, OK. Oh, it was paid already was already posted. OK, so this was paid around [PII].
[AGENT][NEUTRAL] Uh, we, we sent the payment on [PII], so that probably makes sense when it posted on one.
[CUSTOMER][NEUTRAL] 3324.
[CUSTOMER][POSITIVE] OK, alright, alright, thank you, [PII]. I appreciate that. Do you have, you have one of those reference numbers for this call?
[AGENT][NEUTRAL] Uh, it's just my name and today's date. And can I help you with anything else today?
[CUSTOMER][POSITIVE] No, I think that was it. Thank you very much. That was all.
[AGENT][POSITIVE] OK, thanks for calling APL have a good weekend.
[CUSTOMER][POSITIVE] Thank you you too bye now.