AccountId: 011433970860
ContactId: 03813d0e-a7f7-4cf6-8ea5-683369548e5b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 187839 ms
Total Talk Time (AGENT): 81321 ms
Total Talk Time (CUSTOMER): 69615 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/03813d0e-a7f7-4cf6-8ea5-683369548e5b_20250219T13:18_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] from SJC General Surgery, and I was trying to cut uh check claim status on a patient.
[AGENT][NEUTRAL] Sure, [PII], I can assist you with that. Can I have a callback number for you and that policy number?
[CUSTOMER][NEUTRAL] Sure, [PII].
[CUSTOMER][NEUTRAL] And policy number is 02362054.
[AGENT][NEUTRAL] Could you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] And you're calling to check the status of a claim for what date of service and I'll be able to assist you.
[CUSTOMER][NEUTRAL] Uh, data service [PII].
[CUSTOMER][NEUTRAL] $181.
[AGENT][NEUTRAL] Um, do you have procedure code?
[CUSTOMER][NEUTRAL] Um, I do. It's a 99232.
[AGENT][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] I'm calling to check the status of the claim. This claim was submitted on [PII]. It was processed [PII]. There was no payment made on this claim because the policy does not cover services that was provided.
[CUSTOMER][NEUTRAL] OK, so the patient doesn't have inpatient?
[AGENT][NEGATIVE] It states no benefits for doctors and patient visit charges. So basically just the facility charge is covered, but not the doctors.
[AGENT][NEUTRAL] The professional fees.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And if you wanna get a breakdown of this benefit, the policy benefits, then I can transfer you to the queue so they can better assist you.
[CUSTOMER][NEUTRAL] Uh, no, that's fine. Um.
[AGENT][NEUTRAL] And I apologize. What was your name again?
[CUSTOMER][NEUTRAL] All right, so don't.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] What were you about to ask me [PII]?
[CUSTOMER][NEUTRAL] Um, yeah, so it sounds like they have probably some type of like a limited policy then.
[AGENT][NEUTRAL] Hospital indemnity policy, yes, ma'am, they do.
[CUSTOMER][NEUTRAL] OK, so limited policy, OK.
[AGENT][NEUTRAL] Would you like the claim number?
[CUSTOMER][POSITIVE] Um, sure, thank you.
[AGENT][NEUTRAL] 3479062. It's 3479062.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. And what was your
[AGENT][NEUTRAL] My name is [PII], and today's date is a reference, [PII] because we don't provide reference numbers.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. Thank you so much and have a good rest of your day.
[AGENT][POSITIVE] Thanks for calling APA. You have a great one as well, Mada. Goodbye.
[CUSTOMER][POSITIVE] Thanks bye bye.