AccountId: 011433970860
ContactId: 2d9f85b5-22ad-4036-a462-ac1e4a3339c1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 327369 ms
Total Talk Time (AGENT): 131832 ms
Total Talk Time (CUSTOMER): 89472 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/2d9f85b5-22ad-4036-a462-ac1e4a3339c1_20250319T14:51_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII]. Last initial is uh calling from provider office.
[AGENT][NEUTRAL] Oh, hi, good morning. And do you mind spelling your name for documentation, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And it's MOHD mode?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][POSITIVE] Thank you much. And a callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And what is the policy number for the patient, please?
[CUSTOMER][NEUTRAL] 021-73270
[AGENT][NEUTRAL] And what is the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] File month, date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, thank you. And what, how can I help you with this policy?
[CUSTOMER][NEUTRAL] General claim status.
[AGENT][NEUTRAL] Alright, I can help you with that claim status. What is the data service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the first, um, build them out, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The amount is
[CUSTOMER][NEUTRAL] $1,471 even.
[AGENT][NEUTRAL] And what is the facility name, please?
[CUSTOMER][NEUTRAL] BU Medical Center.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Excuse me. [PII], I'm showing that we did receive that claim on [PII].
[AGENT][NEUTRAL] And processed on [PII].
[AGENT][NEUTRAL] And the claim
[AGENT][NEUTRAL] was denied as the policy does not provide benefits for conditions other than a sickness or an injury.
[CUSTOMER][NEUTRAL] Could you please repeat?
[AGENT][NEUTRAL] Mhm. The policy does not provide benefits.
[AGENT][NEUTRAL] For the treatments of conditions.
[AGENT][NEUTRAL] Other than a sickness.
[AGENT][NEUTRAL] Or injury and that is per the patient's plan.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Would you like a claim number?
[CUSTOMER][NEUTRAL] OK. Could you please repeat?
[AGENT][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Could you please repeat one more time? The policy does not provide benefits after that?
[AGENT][NEUTRAL] For the treatment.
[AGENT][NEUTRAL] Of conditions other than.
[AGENT][NEUTRAL] Injury or sickness?
[CUSTOMER][NEUTRAL] Injury
[AGENT][NEGATIVE] Sickness
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So what can we do for this claim?
[AGENT][NEUTRAL] Um, that would be determined by the provider, but there are no benefits payable under this policy due to the diagnosis.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. So, what was the claim number?
[AGENT][NEUTRAL] Claim number is 340.
[AGENT][NEUTRAL] 826 7.
[CUSTOMER][NEUTRAL] 3408267
[AGENT][POSITIVE] Yes, sir, that's right.
[CUSTOMER][NEUTRAL] So what can we do? Did you provider right up or anything else?
[AGENT][NEUTRAL] That would be determined by the provider. We're not major medical and we do not determine patient responsibility, or if you can bill the patient, we don't determine that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Please provide me your name and callback number.
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And the reference number is my name and today's date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And it's been a pleasure to assist you with that claim status, [PII]. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, thank you so much.
[AGENT][POSITIVE] Well, thank you for calling APL and I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] OK, bye-bye.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Yeah.