AccountId: 011433970860
ContactId: 11c23f52-e765-4ab9-af06-05cacf4b55e0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 238679 ms
Total Talk Time (AGENT): 114395 ms
Total Talk Time (CUSTOMER): 81667 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/11c23f52-e765-4ab9-af06-05cacf4b55e0_20250507T15:40_UTC.wav
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[AGENT][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Hi, good morning. I'm sorry, your name again?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] [PII], good morning, [PII]. My name is [PII], and I'm calling from faculty physicians and surgeons, and I'm calling for more information on a claim that we received a denial. I was wondering if you could provide more information.
[AGENT][NEUTRAL] I can certainly do that and um when I go to the.
[CUSTOMER][NEUTRAL] I'm sorry, I could barely hear you.
[AGENT][NEUTRAL] OK, can you, can you hear me a little better now?
[CUSTOMER][NEUTRAL] Uh, it's, uh, barely.
[AGENT][NEUTRAL] OK, well, what I'm looking for is the policy number, please?
[CUSTOMER][NEUTRAL] Oh, they're there.
[CUSTOMER][NEUTRAL] Policy number is 025043662.
[AGENT][NEUTRAL] 362. OK, thank you. And the date of service?
[CUSTOMER][NEUTRAL] Data service [PII].
[AGENT][NEUTRAL] OK, I'm sorry, you said what was the date of service again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Great, thank you. I'm gonna go ahead and look that up. If I just have a callback number, please, in the event that we're disconnected.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, I do appreciate that.
[AGENT][NEUTRAL] Excuse me just a moment, please. I'm just looking this up.
[AGENT][NEUTRAL] OK, thank you. Um, this is for anesthesia, is that correct?
[CUSTOMER][NEUTRAL] Uh, let's see here.
[CUSTOMER][NEUTRAL] Yes, anesthesia, yes, it is.
[AGENT][NEUTRAL] OK. So the policy is, this is not a, a, a regular, uh, insurance policy. This is a hospital indemnity policy and the only way that it will pay for either surgery or for anesthesia is if both bills are submitted. And then what they will do is they will pay a, a flat rate fee for the surgery and then they will pay a portion.
[AGENT][NEUTRAL] Of the, uh, of that, um, benefit.
[AGENT][NEUTRAL] To the anesthesia. So, um, let's just say that the, uh, the, uh, surgery was $1000 and, uh, this policy paid at 50%. It would, it would be 50% of that $1000 surgery, uh, bill. So if you just send in the surgery bill, that's fine, but if you just send in the, the anesthesia bill, that they won't pay it until we have the surgery bill as well.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, so, uh,
[CUSTOMER][NEUTRAL] So you're missing the surgery bill for.
[AGENT][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Right, for that, for that date of service, um, and that's why it was paid because, uh, um, it pays a percentage of the surgery bill towards the anesthesia.
[CUSTOMER][NEUTRAL] For the data service.
[AGENT][NEUTRAL] And as I mentioned before, this is, this is a hospital indemnity policy. It does not pay, uh, it pays a flat rate benefit.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] And that's why it does that.
[CUSTOMER][NEUTRAL] So this this
[CUSTOMER][NEUTRAL] Got it. OK, so this is policy is in hospital indemnity.
[CUSTOMER][NEUTRAL] Policy.
[AGENT][POSITIVE] That is correct. That is correct, yes.
[CUSTOMER][NEUTRAL] OK, and since we're only billing for the anesthesia, you need to have the surgery bill as well in order to process the claim.
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][POSITIVE] Got it OK.
[AGENT][NEUTRAL] Now, is there anything else at all that I can help you with? um.
[CUSTOMER][NEUTRAL] No, that would be, that would be it because I'm looking at it that patient delivered on the [PII], I think so. No, maybe I'm reading this wrong. Let me look more into it and I will definitely go ahead and do that. Thank you for your information. [PII], is there a reference number to the call?
[AGENT][NEUTRAL] Yes, it's my name. It's Day, and the first letter of my last name is [PII].
[CUSTOMER][POSITIVE] OK. OK, thank you very much. You have a good day.
[AGENT][POSITIVE] Hey thanks for contacting you.