AccountId: 011433970860
ContactId: 384d1a85-708f-4d7c-b535-5eb0961f62ff
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 226940 ms
Total Talk Time (AGENT): 92652 ms
Total Talk Time (CUSTOMER): 109145 ms
Interruptions: 5
Overall Sentiment: AGENT=1.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/384d1a85-708f-4d7c-b535-5eb0961f62ff_20250421T19:09_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hey [PII], my name is [PII]. I'm calling from Akan Regional Medical Center for Claims, please.
[AGENT][NEUTRAL] Sure, I could check on a claim for you. I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] A [PII], that is [PII].
[AGENT][POSITIVE] OK thank you and then can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] Uh yes, the callback number is [PII].
[AGENT][NEUTRAL] Thank you. And then did you have that policy number?
[CUSTOMER][NEUTRAL] Uh yes, the policy number I have is 02537810.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Uh yes, member's name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that and what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Uh, yes, the date of service I'm looking is uh [PII].
[AGENT][NEUTRAL] OK, and then, uh, do you have that bill amount?
[CUSTOMER][NEUTRAL] Uh yes, that is $4,837.73.
[AGENT][POSITIVE] OK, got it thank you one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. So we did receive this claim. Uh, we were unable to pay a benefit as it was not a covered facility in which this uh surgery took place. It only pays for outpatient surgery in an outpatient hospital or a physician's office.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It or.
[CUSTOMER][NEUTRAL] So you're saying the claim is received and denied due to the
[CUSTOMER][NEUTRAL] Uh, services are noncovered as per patient's policy.
[AGENT][NEUTRAL] Under this policy, yes, um, outpatient surgery is only covered in outpatient hospital or physician's office.
[CUSTOMER][NEUTRAL] Under the
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][POSITIVE] OK, got it. Uh, thank you so much for that information and the balance is patient responsibility.
[AGENT][NEUTRAL] We don't say what is patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] OK, got it, thank you so much, [PII] for that information and um uh can you please give me the date when the claim was received and also the claim number please?
[AGENT][NEUTRAL] Sure, uh, let's see, so that claim number is 354-62227.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] So that number is 3546.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] And that was received [PII].
[CUSTOMER][NEGATIVE] That was January. Mhm and denied.
[AGENT][NEUTRAL] Oh excuse me, I'm sorry, that was awkward. I'm sorry, um, that was when it was processed we received the claim, uh, [PII].
[CUSTOMER][NEUTRAL] I'm sorry, um, that was why it was.
[CUSTOMER][NEUTRAL] OK, and processed on [PII] as you said, right?
[AGENT][POSITIVE] Yes, I apologize, yes.
[CUSTOMER][POSITIVE] Thank you. That's totally fine. And uh lastly if you can provide me with the call reference number for this call, please.
[AGENT][NEUTRAL] Sure, that would just be my first name, last initial, and today's date. So my name is spelled [PII] Last initial is [PII] Was there anything else I could help you with?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] No thank you.
[CUSTOMER][POSITIVE] Thank you so much. That's all. Thank you so much.
[AGENT][POSITIVE] Alright, yeah, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] You too take care.
[AGENT][POSITIVE] Thank you bye