AccountId: 011433970860
ContactId: 3497df67-eef8-431c-8701-95eb4879c4e2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 448600 ms
Total Talk Time (AGENT): 89848 ms
Total Talk Time (CUSTOMER): 117607 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/3497df67-eef8-431c-8701-95eb4879c4e2_20250407T17:56_UTC.wav
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[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from the provider office, checking for the claim status.
[AGENT][POSITIVE] Alright, I'm happy to check on a claim for you today, [PII]. What's the policy number?
[CUSTOMER][NEUTRAL] Um, just a moment.
[CUSTOMER][NEUTRAL] The policy number is going to be 02557111.
[AGENT][NEUTRAL] And do you have a good call back number?
[CUSTOMER][NEUTRAL] [PII] and it's a direct line.
[AGENT][NEUTRAL] Thank you. And then can I get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's first name is [PII] and the last name is [PII]. The date of birth is [PII].
[AGENT][POSITIVE] Thank you and then data service.
[CUSTOMER][NEUTRAL] The [PII], the bill amount $934.96.
[AGENT][NEUTRAL] $34.96.
[CUSTOMER][NEUTRAL] Yes, $934.96.
[AGENT][NEUTRAL] Is this a medical claim or a dental claim?
[CUSTOMER][NEUTRAL] Medical claim
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And I apologize, can you repeat the bill amount once more?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] $934.96.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] So I'm not showing any claims on file for $934.96 for date of service [PII].
[CUSTOMER][NEUTRAL] Previously, we have received the
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] It will be also.
[AGENT][NEUTRAL] What's the claim number?
[CUSTOMER][NEUTRAL] The claim number is 356-075-9.
[AGENT][NEUTRAL] Uh, this is showing, uh, denied ambulance benefits are only payable if the insured is admitted to the hospital as inpatient.
[CUSTOMER][NEUTRAL] What is the exact denial reason? Could you please explain me?
[AGENT][NEUTRAL] Benefits not payable since the patient was not admitted as inpatient.
[CUSTOMER][NEUTRAL] It was not
[CUSTOMER][NEUTRAL] So previously,
[CUSTOMER][NEUTRAL] So, the insured only take in the ambulance services.
[CUSTOMER][NEUTRAL] And if the patient is an inpatient, could you please provide me the inpatient date range?
[AGENT][NEUTRAL] Patient would have to be in in the hospital for 18 hours or longer to be considered inpatient.
[CUSTOMER][NEUTRAL] Uh, not for 18 hours. So it's for 24 hours, right?
[CUSTOMER][NEUTRAL] Within a day
[CUSTOMER][NEUTRAL] So the denial is incorrect.
[CUSTOMER][NEUTRAL] So we are calling from the ambulance services. The member have taken the emergency ambulance services on a date of service [PII].
[AGENT][NEUTRAL] Yes, and if the patient was, if the patient was admitted to the hospital, then benefits would have been payable, but since the patient was not admitted, nothing is payable.
[CUSTOMER][NEUTRAL] It's not about the
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, but the member have taken the ambulance services, so the policy will cover under the uh for ambulance services will cover for the patient.
[AGENT][NEUTRAL] Only if they're inpatient.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][POSITIVE] Thank you. Could you please spell your name?
[AGENT][NEUTRAL] My name is spelled [PII].
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And what is our call reference number?
[AGENT][NEUTRAL] Call references my name with my last initial than today's date, my last initials [PII].
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you so much for your assistance. Have a great day. Bye-bye.