AccountId: 011433970860
ContactId: 098b1135-a35c-49dc-a016-78006a4a8c32
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 311519 ms
Total Talk Time (AGENT): 116509 ms
Total Talk Time (CUSTOMER): 127758 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/098b1135-a35c-49dc-a016-78006a4a8c32_20250403T15:59_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII], and I am calling from Titus Regional Medical Center Hospital, ma'am, and looking for the same status today.
[AGENT][NEUTRAL] OK, sure. I can assist you with claim status, Ms. [PII]. Can you repeat the name of the hospital?
[CUSTOMER][NEUTRAL] It's Titus Regional Medical Center Hospital.
[AGENT][NEUTRAL] You said Titus?
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK. OK. Thank you.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Uh, before sharing patient details, I want to confirm you this call may be recorded for quality and training purposes. So you want to proceed?
[AGENT][NEUTRAL] Sure, yes.
[CUSTOMER][NEUTRAL] It's 02421577. Can you spell out your name?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Sure, that's [PII]. That's [PII]. Last initial is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. And what's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Uh, it's [PII], [PII].
[AGENT][POSITIVE] All right, perfect. Thank you.
[AGENT][NEUTRAL] And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Oh my.
[CUSTOMER][NEUTRAL] $1,354.46 total and date of service [PII].
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment, let me see if I can find this claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Good
[CUSTOMER][NEUTRAL] to
[AGENT][NEUTRAL] And that was $1,654.46?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, and I have claim number also, so.
[AGENT][NEUTRAL] OK. Bear with me just a second.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] All right. And how may I assist you with this claim?
[AGENT][NEUTRAL] You say you already have the claim number?
[CUSTOMER][NEUTRAL] Looking for the claim status.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. Um, let me give you, give you the denial reason this claim was denied. It was processed on [PII].
[AGENT][NEUTRAL] And the denial reason is, let's see.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, the outpatient rider rider only allows benefits for surgery.
[CUSTOMER][NEUTRAL] the
[AGENT][NEUTRAL] So it's this is an uncovered service.
[CUSTOMER][POSITIVE] you're doing well.
[CUSTOMER][NEUTRAL] Uh-huh, uh, can you repeat one more time?
[AGENT][NEUTRAL] OK, the outpatient rider.
[AGENT][NEUTRAL] Only allows payments for outpatient surgery.
[AGENT][NEUTRAL] So an ER visit is not covered under this plan.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So claim is denied due to service not covered under the patient plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Which service?
[AGENT][NEUTRAL] ER visits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEGATIVE] ER is not covered under this plan.
[CUSTOMER][NEUTRAL] ER visits. So patient taking the ER visit, which is not covered under the patient plan, right?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And claim number is
[CUSTOMER][NEUTRAL] 202-501-080112, right? So,
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Claim number?
[AGENT][NEUTRAL] The claim number is 3553262.
[CUSTOMER][NEUTRAL] And is, uh, is there any paid amount in this claim?
[AGENT][NEGATIVE] No, it was denied. It's an uncovered service.
[CUSTOMER][NEUTRAL] Again, claim number 3553262, right?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] Call reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] So, OK. Thank you so much and have a great day. Bye.
[AGENT][POSITIVE] You as well. Thank you for calling APL.
[CUSTOMER][NEUTRAL] Yeah