AccountId: 011433970860
ContactId: 04ef24f7-7d13-461c-877b-64af961fa298
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 216610 ms
Total Talk Time (AGENT): 52650 ms
Total Talk Time (CUSTOMER): 88365 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/04ef24f7-7d13-461c-877b-64af961fa298_20250604T16:04_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Um, hello. Uh, good morning. This is [PII]. I'm calling on behalf of Ponsa Cos Hospitals. I would like to check on a claim status, please.
[AGENT][POSITIVE] I'd be happy to assist with claim status. Can you pronounce your first name for me again please?
[CUSTOMER][NEUTRAL] Uh yes, ma'am. That would be, I'm going to spell that for you. That would be [PII], and the first letter of my last name would be [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] And if I can get a good call back number for you?
[CUSTOMER][NEUTRAL] Uh yes, that would be [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] The policy number, uh, let me see that.
[CUSTOMER][NEUTRAL] Uh, policy number would be 023.
[CUSTOMER][NEUTRAL] 34378.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] Um, his name is [PII], and date of birth will be [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. I do show the policy is currently active. Effective date is [PII]. And will this be for inpatient or outpatient benefits?
[CUSTOMER][POSITIVE] Oh, I'm sorry?
[AGENT][NEUTRAL] Are you calling for inpatient or outpatient benefits?
[CUSTOMER][POSITIVE] Impatient.
[AGENT][NEUTRAL] I'm showing the inpatient calendar year maximum is $3000.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Was there anything else I can assist with today?
[CUSTOMER][NEUTRAL] Um, let me see, uh, yes, I wanted to, uh, like see the status of the claim that we have in here. Maybe I can provide you with the um, service date.
[AGENT][NEUTRAL] What's the date of service?
[CUSTOMER][NEUTRAL] Uh, it will be [PII].
[AGENT][NEUTRAL] And your tax ID?
[CUSTOMER][NEUTRAL] Tax ID [PII].
[AGENT][NEGATIVE] I'm showing the claim denied because the office visit, uh, physician's charges are not covered under the policy.
[CUSTOMER][NEUTRAL] Mm OK.
[CUSTOMER][NEUTRAL] So, in this case, if the um insured uh does not have another insurance, uh, that will be like uh totally his responsibility, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] All right, perfect. Um, and thank you very much for the information. Um, you told me that your name is [PII], correct?
[AGENT][NEUTRAL] [PII] last initial is [PII].
[CUSTOMER][POSITIVE] Perfect, thank you very much. Maybe do you have like a reference number for the call?
[AGENT][NEUTRAL] Reference is just my name and today's date and time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect, [PII]. Thank you very much for all the information you provided to me.
[AGENT][POSITIVE] Thank you for calling APO you have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.