AccountId: 011433970860
ContactId: 3177cad2-bf2d-48a5-9bb0-3995e02d8a90
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 638239 ms
Total Talk Time (AGENT): 133926 ms
Total Talk Time (CUSTOMER): 92797 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/3177cad2-bf2d-48a5-9bb0-3995e02d8a90_20250218T15:52_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] Hey [PII], my name is [PII]. I'm calling from the insurance follow-up department at Providence Little Company of Mary Medical Center. Boy, that's a mouthful. Um, I am trying to ensure that this patient's denial is correct, um, and that he's not covered for emergency room services.
[AGENT][NEUTRAL] OK, well, I can definitely um give you some clarity with the denial. And [PII], may I have a good contact number in case we're disconnected and then the policy number?
[CUSTOMER][NEUTRAL] Sure, telephone number is [PII] with confidential voicemail.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, the ID number is [PII].
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] The patient is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service or the claim number for the claim?
[CUSTOMER][NEUTRAL] Um, sure, the date of service is [PII].
[CUSTOMER][NEUTRAL] We billed $7,337.75.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] OK, so the the claim was denied because premium for that data service had not been received, so benefits could not be paid out. um.
[AGENT][NEUTRAL] The policy now though?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] The policy is now active.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief, well, hold on, actually, I just found it. Sorry.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No worries.
[AGENT][NEUTRAL] 2023.
[AGENT][NEUTRAL] OK, yeah, no, this is a different data service. um, can I place you on just a brief hold?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, wait a minute. So like.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII]?
[CUSTOMER][NEUTRAL] Yeah, I'm here.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. I'm trying to see if since the policy is still active, because sometimes when we get that message, the policy is no longer active, but since it's still active, if whenever the payment was received, if it um
[AGENT][NEUTRAL] If it goes back and covers outstanding balances or if it just um starts from when they, um, you know, notify us that the payment has been made, um, so to see if we can send this back for reprocessing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So does he have benefits available for emergency room?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, the only reason I'm asking is I do have an EOB that says service description non-covered procedure.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Was he admitted or he was only at the emergency room, or did it turn into an admission?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And emergency room only.
[AGENT][NEUTRAL] OK, so then, no, the policy doesn't have um emergency room coverage.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it's a hospital indemnity policy, but it um it does have admission benefits or confinement benefits, but not for emergency room.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May have been covered if patient admitted, they have been covered.
[CUSTOMER][POSITIVE] Yeah, makes sense.
[CUSTOMER][NEUTRAL] Ha.
[CUSTOMER][NEUTRAL] OK, super. All right and then do you have a call reference number?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. Um, the first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] And it was [PII], is that right?
[AGENT][POSITIVE] Yes, that's, that's correct. [PII]
[CUSTOMER][POSITIVE] Oh, OK, super. OK, awesome. All right, [PII], thanks so much for your help. I appreciate it.
[AGENT][POSITIVE] You're very welcome and thanks for calling APL Shirl. I hope you have a great day.
[CUSTOMER][POSITIVE] Thanks you too. Bye-bye.
[AGENT][NEUTRAL] Bye bye.