AccountId: 011433970860
ContactId: fa32489b-103d-44b7-9a43-e4ff11691869
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 336399 ms
Total Talk Time (AGENT): 120635 ms
Total Talk Time (CUSTOMER): 119349 ms
Interruptions: 1
Overall Sentiment: AGENT=1.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/fa32489b-103d-44b7-9a43-e4ff11691869_20250403T13:12_UTC.wav
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[AGENT][POSITIVE] Good morning.
[AGENT][NEUTRAL] APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], and I'm calling from Atrium Medical Center about a claim.
[AGENT][NEUTRAL] OK, I'm so sorry, but there is an echo on our call and I was not.
[AGENT][NEUTRAL] A
[CUSTOMER][NEUTRAL] Hold on 1 2nd.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Cool
[CUSTOMER][NEUTRAL] Can you hear me better now?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][POSITIVE] Yes, ma'am, that is much better.
[CUSTOMER][NEUTRAL] OK, yes, I was calling about a claim. Um, we received a $50 payment and it shows what this check, the maximum benefit payable for the state of service has been met. I just wanna make sure this is an indemnity plan and the balance is the patient's responsibility.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so you've reached
[AGENT][NEUTRAL] Received a payment on a claim and you're wanting to verify the type of coverage, the type of plan.
[CUSTOMER][NEUTRAL] I'm sorry, you cut out.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And you said your name is [PII], right?
[AGENT][POSITIVE] Yes, ma'am, I can help you
[AGENT][NEUTRAL] I did, yes, ma'am. And what is your name again? Because I wasn't able to understand you before.
[CUSTOMER][NEUTRAL] Yeah, [PII]
[AGENT][NEUTRAL] OK, [PII]. Thank you. And your callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And [PII], what is the member's policy number?
[CUSTOMER][NEUTRAL] The policy number is 02580380.
[AGENT][NEUTRAL] OK, thank you. One moment while I get all of the members' information pulled up please, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII]. And I do have a claim number also.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, right, first off, what is the date of service and total bill amount?
[CUSTOMER][NEUTRAL] It's [PII] for $7,225.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And now the claim number, please.
[CUSTOMER][NEUTRAL] It's 355-9560.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so yes ma'am, I do have that claim pulled up and I can see that the $50 benefit was issued on this claim and yes ma'am, this is a hospital indemnity limited benefit plan.
[AGENT][NEUTRAL] Now APL does not determine patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] OK, but all you pay is $50 is it for an emergency room?
[AGENT][NEUTRAL] Yes, ma'am, for this.
[AGENT][NEUTRAL] That is correct on this limited benefit plan. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, and you said it's a limited indemnity limited hospital plan, correct?
[AGENT][NEUTRAL] It's a hospital indemnity limited benefit plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. And do you have a call reference number?
[AGENT][NEUTRAL] Yes ma'am, uh, you would use my name along with today's date and then [PII], just one additional piece of information for you. In the future, if you were to need one of our explanation of benefits, we do have a portal in which you should be able to access that.
[CUSTOMER][NEUTRAL] Right, I tried to get on the, yeah, I'm on the portal, but the, the detail on the remit, it just says $50 so I just wanted to make sure because with the no surprise billing.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][POSITIVE] Good.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] So, all right. Well, I appreciate your help. Thanks, [PII]. Have a good day.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Well, you, uh, you're certainly welcome. So again.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][POSITIVE] That is all I can help you with. I hope you have a great day as well, and thank you for Kel this morning, [PII].
[CUSTOMER][NEUTRAL] Bye-bye.