AccountId: 011433970860
ContactId: 27ddc9a6-0298-4058-bc0f-40e06f78c432
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 356450 ms
Total Talk Time (AGENT): 93105 ms
Total Talk Time (CUSTOMER): 78641 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/27ddc9a6-0298-4058-bc0f-40e06f78c432_20250114T17:23_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from Alo Health. Um, I need to check claim status for a patient, please.
[AGENT][NEUTRAL] OK, do you have a callback number I can get in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] Yeah, phone number is [PII], no extension.
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] I don't have the uh policy number, but I can give you a social.
[AGENT][NEUTRAL] OK, I can look it up by the social.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII], hold on one moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the patient's name? I couldn't pull up that social.
[CUSTOMER][NEUTRAL] OK. It's uh [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And how do you spell her first name? [PII]
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] OK, hold one moment, let me see if I can find it by the name.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's her date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII], and you were needing claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I can look that up for you. What date of service?
[CUSTOMER][NEUTRAL] It's gonna be [PII].
[AGENT][NEGATIVE] The policy is not in her name. That's why I couldn't find it.
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[AGENT][NEUTRAL] And you said it was 9:13 or 93?
[CUSTOMER][NEUTRAL] 9324.
[AGENT][NEUTRAL] 93. OK. What's one of the procedure codes that was on that bill? I have several.
[CUSTOMER][NEUTRAL] OK, let me see, go back to it. So, um, it's gonna be 99396.
[AGENT][NEUTRAL] 99396. OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is that the only one that was on there or it was several more? OK.
[CUSTOMER][NEUTRAL] No, it's um it looks like it should be.
[CUSTOMER][NEUTRAL] A total of 19, but um a total of 9, the actual have charges.
[AGENT][NEGATIVE] OK, we did receive the claim. It was denied. Hold on, let me see why it was denied.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, the 99396 was denied for wellness not covered?
[AGENT][NEUTRAL] Let's see why the other codes were denied.
[AGENT][NEUTRAL] OK. The others were denied. The outpatient rider only allows payment for outpatient surgery in an outpatient hospital or physician office. Therefore, no benefits are payable.
[CUSTOMER][NEUTRAL] That's for the uh remaining, remaining codes.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, only allow payment for outpatient, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, and is there a reference number for this call?
[AGENT][NEUTRAL] We do not have reference numbers you can use my name in today's date.
[CUSTOMER][POSITIVE] OK, good deal thank you so much.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] No, that's all I have.
[AGENT][POSITIVE] Thank you, [PII], for calling APO. You have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.