AccountId: 011433970860
ContactId: ff9a786c-6ff6-4439-900e-51cc58c5a661
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 359679 ms
Total Talk Time (AGENT): 140800 ms
Total Talk Time (CUSTOMER): 118967 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/ff9a786c-6ff6-4439-900e-51cc58c5a661_20250326T15:16_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Uh yes, this is [PII].
[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How can I help you? Hi, [PII].
[CUSTOMER][NEUTRAL] Hi, hi, I, I was just gonna ask, can you hear me?
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] Um, yes, this, this is [PII] with CEP America. The reason for my call, OK, great, um, the reason for my call is we did receive an explanation of benefits for, um, a patient that had a recent visit, and it is stating.
[AGENT][NEUTRAL] Ma'am, I can.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Maximum benefit for the outpatient sickness writer has been exhausted for the calendar year, but it does not state whether this um claim should be patient responsibility or whether it's just being denied as a whole so I wanted to get a little clarification on on that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, [PII], so you're needing clarification on a denied claim, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] My direct line [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] Uh, policy number is
[CUSTOMER][NEUTRAL] 02458169
[AGENT][NEUTRAL] OK, thank you. Give me a couple moment to get the member's information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, [PII], any information that is provided would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Patient's name [PII]. Date of birth [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the data service, [PII]?
[AGENT][NEUTRAL] The total bill amount that you're calling about, please?
[CUSTOMER][NEUTRAL] Data service is.
[CUSTOMER][NEUTRAL] Yes, uh, data service is 10-18-2024 full billed amount $832.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and do you have the claim number?
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Yes, claim number 3561272.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] OK, so yes, ma'am, I can see the remark that states the maximum benefit for the outpatient sickness rider has been exhausted for the calendar year. Now, we are not a major medical insurance company, [PII]. This is a hospital indemnity limited benefit plan, so we do not deter.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Imine patient responsibility that would be up to the pro.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I'm so sorry you you the phone cut out.
[AGENT][NEUTRAL] Are you
[AGENT][NEUTRAL] Still there, [PII]?
[CUSTOMER][POSITIVE] I'm so sorry. Yes, I'm, I'm here. Can you hear me?
[AGENT][NEUTRAL] I don't know why. I've had a problem all week and I think it's, it's, yes, ma'am, and it must be something with my system. I'm not sure though, um, but I apologize about that. So I, yes, we are not a major medical insurance company. This was, this plan is a limited benefit hospital indemnity plan. So, therefore, we do not determine patient responsibility. That would be up to the provider.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, we will go ahead and take care of that on our end and then um I don't have any other questions on this account, but would you have a reference for this call?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am, you would actually use my name along with today's date and just for future reference also [PII], if you all ever should need to check claim status with APO once the claim has been processed, we do have a portal.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] But you should be able to check that in by going to
[CUSTOMER][POSITIVE] OK, great.
[AGENT][NEUTRAL] [PII]. Again, in case it cut out on you, the website is secured. [PII].
[CUSTOMER][POSITIVE] OK perfect well thank you so much [PII] for your help and you have a wonderful day.
[AGENT][POSITIVE] Well, well, yes, ma'am, you too. If that is all I can help you with, thank you again for calling APL too, [PII].
[CUSTOMER][POSITIVE] Thank you. All right, have a good day bye.
[AGENT][POSITIVE] You're welcome. You too. Bye bye.
[CUSTOMER][NEUTRAL] Alright bye.