AccountId: 011433970860
ContactId: 1bdd3b8e-2ec8-4d18-a209-92468fb6c423
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 503329 ms
Total Talk Time (AGENT): 151392 ms
Total Talk Time (CUSTOMER): 104264 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/1bdd3b8e-2ec8-4d18-a209-92468fb6c423_20250320T15:51_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh yeah, hi, this is [PII] calling from provider's office regarding payment status.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Uh yeah, uh, the callback number is going to be [PII].
[AGENT][NEUTRAL] OK. And what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] It's Roper Saint Francis Hospital.
[AGENT][NEUTRAL] OK. And may I have the spelling of your name?
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] Right, OK. Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Just a moment. Uh, the policy number I have it is 021-72946.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] May I have the name and
[CUSTOMER][NEUTRAL] What's your name, by the way?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Your name, what is your name?
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Oh, my name is [PII]. That's [PII], last [PII] [PII].
[CUSTOMER][NEUTRAL] OK, got it. Uh, the patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, perfect. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Get your services 1324.
[CUSTOMER][NEUTRAL] Um, the amount is $1,808.
[AGENT][NEUTRAL] OK, can you repeat that date one more time? I didn't quite catch that.
[CUSTOMER][NEUTRAL] Uh yeah.
[CUSTOMER][NEUTRAL] 6 1324.
[AGENT][NEUTRAL] 6 1324.
[AGENT][NEUTRAL] OK. All right, let me see if I can find this claim for you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, about one.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, bill amount is 1808.
[AGENT][NEUTRAL] OK, yes, I see that. OK, let me pull this ELB one moment, OK?
[CUSTOMER][POSITIVE] Take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] I'm still waiting on the system. OK, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right. So it looks like we processed this claim on [PII] and the claim was denied. And the reason for this denial is that let's see.
[AGENT][NEUTRAL] The outpatient sickness rider allowed payment for sickness only. So it looks like this was an accident and it doesn't cover accidents.
[CUSTOMER][NEUTRAL] Oh sorry, can you please repeat the address?
[AGENT][NEUTRAL] The denial reason is that outpatient sickness rider only allows payment for sickness only.
[AGENT][NEUTRAL] And this claim has been noted as an accident.
[CUSTOMER][NEUTRAL] OK. So, uh, it is outpatient sickness rider.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Only allows benefits for sickness.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] And what does it mean? Can you please explain?
[AGENT][NEUTRAL] What does it, I'm sorry, you said what does it mean?
[CUSTOMER][NEUTRAL] Yeah, I mean to say, uh, can you please uh explains.
[AGENT][NEUTRAL] It means
[AGENT][NEUTRAL] It's not, it's not a cover service that, um, an accident is not a cover service under this policy.
[CUSTOMER][NEUTRAL] OK, so you mean to say that uh the patient made an accident, right?
[AGENT][NEUTRAL] No, it means that uh this claim was an accident claim, and this policy is only for sickness.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so this claim is an accident claim, but you guys only cover sickness, not for accidents.
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] Correct, yes. Mhm.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Just a moment, let me note it down.
[AGENT][POSITIVE] Oh sure, yeah, take your time.
[CUSTOMER][NEUTRAL] And can you please check is there any other insurance member having or not?
[AGENT][NEUTRAL] Um, I can check and see.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No, um, he doesn't have any other policies with us.
[CUSTOMER][POSITIVE] OK, uh, no worries. Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And what's your, OK, yeah, you told me your name. What's the claim number, by the way?
[AGENT][NEUTRAL] The claim number is 3,477,040.
[CUSTOMER][NEUTRAL] 347-7040, right?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] Yeah, and the call reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name and today's date if you will.
[AGENT][NEUTRAL] Mr. [PII].
[CUSTOMER][POSITIVE] OK, no worries.
[AGENT][NEUTRAL] is there anything else I may help you with today?
[CUSTOMER][POSITIVE] Yeah. Thank you so much.
[CUSTOMER][POSITIVE] Uh, no, actually I'm done. Bye bye, take care.
[AGENT][POSITIVE] You as well. Thank you for calling APL. Have a good day. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah, bye bye.