AccountId: 011433970860
ContactId: 37c5a103-3a7f-466a-bfd4-21d1e5742f05
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 271700 ms
Total Talk Time (AGENT): 99695 ms
Total Talk Time (CUSTOMER): 93797 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/37c5a103-3a7f-466a-bfd4-21d1e5742f05_20250402T19:13_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I'm [PII]. Last name is [PII]. I want to uh check claim status.
[AGENT][NEUTRAL] OK, I can help you with the claim status bill. May I have a good contact number in case we're disconnected?
[CUSTOMER][POSITIVE] Yeah, that is [PII] and this is it is right.
[AGENT][NEUTRAL] Thank you. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Only one.
[AGENT][NEUTRAL] All right. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, that's going to be.
[CUSTOMER][NEUTRAL] 022 06104.
[AGENT][NEUTRAL] 022 06104.
[CUSTOMER][NEUTRAL] No, 022 06104.
[AGENT][NEUTRAL] And may I have the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Your name is [PII] and the 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 for the claim and the total bill?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yeah, this claim I do have the claim number. Do you want that or?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah, the claim number is 3563562153.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] I know that
[AGENT][NEUTRAL] OK, and what questions did you have about the um claim?
[CUSTOMER][NEUTRAL] Yeah. Uh, this claim is denied uh because.
[CUSTOMER][NEUTRAL] Uh, treatment and outpatient hospital are not covered, no?
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Treatment in an outpatient hospital less than 18 hours is not covered by this policy.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK. And is there any patient responsibilities for this uh claim?
[AGENT][NEUTRAL] Um, we don't determine patient responsibility because we're not a major medical company, but we also did not pay out on this claim. So if there is an outstanding balance or remaining balance, um, it would be up to the provider.
[AGENT][NEUTRAL] Next steps.
[CUSTOMER][NEUTRAL] OK it's uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Then there's no patient responsibility, no.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, uh.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Can you explain a little bit more about that? Uh, do you know the reason?
[AGENT][NEUTRAL] Um, sure. So,
[CUSTOMER][NEUTRAL] Did you want the running.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The outpatient treatment benefit provides an indemnity amount.
[AGENT][NEUTRAL] When a covered person receives treatment in an emergency room, urgent care facility,
[AGENT][NEUTRAL] A physician's office.
[AGENT][NEUTRAL] Or physical speech or occupational therapy facility?
[AGENT][NEUTRAL] Treatment in an outpatient hospital less than 18 hours is not covered by this policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Less than 18 hours, sir.
[AGENT][NEUTRAL] So what was done?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So what was done is not covered by the policy.
[AGENT][NEUTRAL] The patient's policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, then can I have your name and conference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number and my name is [PII] First initial to my last name is [PII], and you can use my name in today's date for the reference number.
[CUSTOMER][POSITIVE] Yeah, thank you for the information. That's all. Have a great day.
[AGENT][POSITIVE] You also, and thanks for calling APL. Bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] It.