AccountId: 011433970860
ContactId: fc008c49-1a30-43e7-931f-8da0d851b041
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 557570 ms
Total Talk Time (AGENT): 224222 ms
Total Talk Time (CUSTOMER): 133560 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/fc008c49-1a30-43e7-931f-8da0d851b041_20250106T16:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name's [PII]. I'm calling from Swedish Medical Center checking on claim status, and I'm sorry, what did you say your name was?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][POSITIVE] [PII], thank you.
[AGENT][NEUTRAL] Yeah, not a problem, [PII]. Do you have the patient's uh policy number?
[CUSTOMER][NEUTRAL] 02567762
[AGENT][POSITIVE] All right, thank you so much. Let me pull this up. And do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] All right, thank you so much. And then what is the patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][POSITIVE] Alright, thank you so much and then what is the date of service?
[CUSTOMER][NEUTRAL] Data service is gonna be [PII].
[AGENT][NEUTRAL] 526 and then the bill amount.
[CUSTOMER][NEUTRAL] Total charge amount is $227,142.99.
[AGENT][NEUTRAL] All right, let's take a look, see what we got here. One moment.
[AGENT][NEUTRAL] Mhm mhm.
[AGENT][NEUTRAL] Let's see
[AGENT][NEUTRAL] OK, so it looks like we have separate claims for each of these dates.
[AGENT][NEUTRAL] Um, give me just a second to.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Because this is inpatient bill, so it shouldn't be separate.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, because when I do like I don't see anything for that full build amount, but we have claims starting like on 122.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 4.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see, so like the first one I put in for date of service [PII]. Let me see what this is for.
[AGENT][NEUTRAL] It was for CarePoint emergency medical, it looks like.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, that would be the doctor.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm not looking for that then.
[CUSTOMER][NEUTRAL] Is the correct address [PII]?
[AGENT][NEUTRAL] No, it should be, let me just double check and make sure. I don't think the claims go to that address. Give me one second, um, [PII], sorry.
[CUSTOMER][POSITIVE] OK. All right, thank you. All right, that's OK, no problem.
[AGENT][NEUTRAL] Let's see here.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so yeah, it looks like claims go to attention to IMA and then the the [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I do show a claim actually I was gonna say do you show a claim that's actually pending um in progress that was submitted reported on [PII].
[CUSTOMER][NEUTRAL] Yeah, 2171.
[AGENT][NEUTRAL] And when I pull that up it looks like that has the amount you gave me the um 22 yeah 20 so maybe just give this a little bit more time before resubmitting because it looks like we maybe did get something for that just hasn't been processed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, is there a claim number or anything yet?
[AGENT][NEUTRAL] No, nothing yet for it. Mm mm.
[CUSTOMER][NEUTRAL] OK, alright, OK, and you said that looked like it was received on [PII]?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] All right. OK.
[AGENT][NEUTRAL] It looks like for H is it HCA health.
[CUSTOMER][NEUTRAL] 1
[AGENT][NEUTRAL] Health One Swedish, yeah.
[CUSTOMER][NEUTRAL] Yeah, that's it. Uh-huh.
[AGENT][NEUTRAL] OK, yeah, so it looks like we do have it. It just hasn't processed yet.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK, alright, and what type of plan is this?
[AGENT][NEUTRAL] So this is a limited benefit or a hospital indemnity plan where it's just gonna pay a set amount depending upon what they're being seen for.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, all right, um, and she was impatient.
[CUSTOMER][NEUTRAL] Uh, let's see if I can tell what she was treated for.
[CUSTOMER][NEGATIVE] Um, looks like cancer.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, yeah, I mean, there's a hospital admission benefit on the plan of $500.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then each day of confinement in the hospital pays like $50. It's a max of like 30 days it looks like.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You said 50 per day?
[AGENT][NEUTRAL] Mhm. It does have, it looks like critical illness on it though too.
[AGENT][NEUTRAL] Um, with cancer being under that umbrella.
[AGENT][NEUTRAL] That then shows it pays a benefit amount of 5000.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's just the one time.
[CUSTOMER][NEUTRAL] For the admission, correct?
[AGENT][NEUTRAL] Yeah, it looks like the uh the admission is one time. Mhm.
[CUSTOMER][NEUTRAL] OK, alright then, and uh is there a reference number?
[AGENT][NEUTRAL] Absolutely. Call reference is going to be my name with my last initial than today's date. Um my name again is [PII] Last initials my name is going to be [PII] and then just today's date.
[CUSTOMER][POSITIVE] Alright, thank you so much. You have a great day.
[AGENT][POSITIVE] My pleasure. Thanks for calling APL. You too.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye bye.