AccountId: 011433970860
ContactId: 019711ce-3fa9-4a7d-827d-fe9822d1b0d4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 176190 ms
Total Talk Time (AGENT): 90535 ms
Total Talk Time (CUSTOMER): 73580 ms
Interruptions: 1
Overall Sentiment: AGENT=2.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/019711ce-3fa9-4a7d-827d-fe9822d1b0d4_20250319T18:37_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, I am calling on a claim that I got a denial and I wanted to speak with you about it, please.
[AGENT][POSITIVE] Sure, it would be my pleasure to assist you and
[AGENT][NEUTRAL] What is your name, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Alright, and a callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. Thank you, [PII]. What is?
[CUSTOMER][NEUTRAL] Mhm and I'm calling from provider's office.
[AGENT][NEUTRAL] All right, thank you. You said you received a denial. Do you have that claim number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, no, I do not.
[AGENT][NEUTRAL] Not a problem. Do you have the patient's policy number?
[CUSTOMER][NEUTRAL] I do it's 02538271.
[AGENT][NEUTRAL] Thank you, [PII] and what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII] [PII].
[AGENT][NEUTRAL] Alright thank you and what is the data service?
[CUSTOMER][NEUTRAL] It is for 123 of 24.
[AGENT][NEUTRAL] And the bill amount?
[CUSTOMER][NEUTRAL] It's for $25,455.61.
[AGENT][NEUTRAL] Thank you. And what is the facility name?
[CUSTOMER][NEUTRAL] Uh, ours is Suncoast Surgical Associates.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] I can give you information regarding that claim. We did receive that claim on [PII]. It was processed on [PII].
[AGENT][NEUTRAL] And this claim was denied because the maximum benefit payable for that data service has been met.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, what kind of policy is this?
[AGENT][NEUTRAL] It is a limited hospital indemnity policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it just provides limited. Did you want that claim number?
[CUSTOMER][NEUTRAL] That explains it.
[CUSTOMER][NEUTRAL] Uh, no, I have it on the the EOB. I just forgot to pull it up before I called. Sorry.
[AGENT][POSITIVE] No problem, no problem.
[CUSTOMER][NEUTRAL] OK, so she has no cover.
[AGENT][POSITIVE] We can always work around that, yeah, then.
[CUSTOMER][NEGATIVE] Yeah she has no coverage then.
[AGENT][POSITIVE] Right, because we've already paid the max benefit for that date.
[CUSTOMER][POSITIVE] Alrighty
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm, somebody else beat us to it, OK.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] I did. Anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that's it, thank you very much.
[AGENT][POSITIVE] [PII], thank you for calling APL, and it was a pleasure to assist you with the claim status. Have a wonderful afternoon.
[CUSTOMER][POSITIVE] Thank you you too bye.
[AGENT][POSITIVE] Thank you. Bye bye.