AccountId: 011433970860
ContactId: 3957cc67-84c7-4fb2-b0ef-eefc969c45d0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 217039 ms
Total Talk Time (AGENT): 91457 ms
Total Talk Time (CUSTOMER): 56547 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/3957cc67-84c7-4fb2-b0ef-eefc969c45d0_20250303T19:43_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes, I'm calling on a claim.
[AGENT][NEUTRAL] Sure, I could check on a claim for you. Uh, what was your name?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, [PII], are you the insured or are you with a provider?
[CUSTOMER][NEUTRAL] Provider.
[AGENT][NEUTRAL] OK, uh, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] It's [PII] and that's the direct number.
[AGENT][NEUTRAL] Thank you. Uh, do you have the policy number?
[CUSTOMER][NEUTRAL] I do. It's 02520609.
[AGENT][NEUTRAL] OK, and then what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Um, [PII], [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII] and uh what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Um, it's [PII] for $155.
[AGENT][NEUTRAL] 55. OK, thank you. One moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Was this, uh, is it Cherokee Medical Center?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK, OK. Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so we did receive this claim, [PII], uh, looks like we were unable to pay a benefit as uh the outpatient benefit only allows payment for outpatient surgery in an outpatient hospital or a physician's office.
[CUSTOMER][NEUTRAL] OK, so you don't pay outpatient labs just outpatient surgery?
[AGENT][NEUTRAL] Uh, yes, in a outpatient hospital or a physician's office. And if you'd like, I can send you a copy of this uh EOB.
[CUSTOMER][NEUTRAL] OK, and would that be patient res because it didn't deny us patient responsibility.
[AGENT][NEUTRAL] Right, we don't say what is patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So is this, is this a medical plan or?
[AGENT][NEUTRAL] Yes, this is a limited indemnity medical plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you want me to send you a copy of the EOB?
[CUSTOMER][NEUTRAL] Um, yes, if you can.
[AGENT][NEUTRAL] Sure. Do you have a fax number?
[CUSTOMER][NEUTRAL] Um, it's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I'm going to read that back to make sure I heard that correctly. That was [PII]?
[CUSTOMER][POSITIVE] That's correct, yes.
[AGENT][NEUTRAL] OK, and I would just put it to your attention, [PII]?
[CUSTOMER][POSITIVE] Uh, yes, that's correct.
[AGENT][NEUTRAL] OK, alright, um, was there anything else I can help you with?
[CUSTOMER][NEUTRAL] Um, no, if I could just get a reference number.
[AGENT][NEUTRAL] Sure, that would just be my first name, last initial, and today's date. Uh so my name is spelled [PII]
[CUSTOMER][POSITIVE] OK. All right, thank you.
[AGENT][POSITIVE] Of course, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] All right, bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.