AccountId: 011433970860
ContactId: 439ecf98-731d-4825-ab2d-7ebac4ed08f0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 297149 ms
Total Talk Time (AGENT): 86529 ms
Total Talk Time (CUSTOMER): 69228 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/439ecf98-731d-4825-ab2d-7ebac4ed08f0_20250318T18:11_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from Pro's office to check on a claim.
[AGENT][NEUTRAL] OK, I can help you, [PII] with the claim. Can I please get your callback number and the name of the provider you're calling for?
[CUSTOMER][NEUTRAL] Oh, sure.
[CUSTOMER][NEUTRAL] The callback number is [PII] and I'm calling from Genesis Medical Anastasia PC.
[AGENT][POSITIVE] OK, thank you so much. And then what's the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] You're welcome. The policy number is 02494771.
[CUSTOMER][NEUTRAL] And the member's name, it's [PII]. Date of birth is on [PII].
[AGENT][NEUTRAL] OK, let me pull his policy in real quick.
[CUSTOMER][NEUTRAL] No question.
[AGENT][NEUTRAL] Alright, and then what is the data service and the charge amount?
[CUSTOMER][NEUTRAL] The date of service is on [PII] for the charge amount of $924 even.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I look this claim up for you, Ms. [PII], and I'll be right back.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh my.
[AGENT][NEUTRAL] 94.
[AGENT][NEUTRAL] It's gonna be 353-236-93532.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you, Ms. [PII] for holding for me. I've got the claim ready for you. It is claim number 353-2369, and the claim was denied because anesthesia is not covered under the patient's policy.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, just a moment. OK, uh, thanks for that information. So may I know when the claim was received and denied?
[AGENT][NEUTRAL] Yes ma'am. It was received on [PII] and it was processed on [PII].
[CUSTOMER][NEUTRAL] OK, so, uh.
[CUSTOMER][NEUTRAL] May I know what plan does the member has?
[AGENT][NEUTRAL] The member has a hospital indemnity plan.
[CUSTOMER][POSITIVE] OK, got it. Thank you. And uh thanks for helping me out.
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][NEUTRAL] And uh do you have the reference number for the call?
[AGENT][NEUTRAL] Yes, ma'am. You can use my name, [PII], and today's date.
[CUSTOMER][POSITIVE] OK, got it, thank you.
[AGENT][NEUTRAL] You're welcome. Is there anything else, Ms. [PII], I can help you with before we go?
[CUSTOMER][POSITIVE] No, thank you for asking and uh thank you for helping me out.
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] You're welcome. You have a wonderful day and thanks for calling APL.
[CUSTOMER][POSITIVE] And you do have a great day, sir. bless bye.
[AGENT][NEUTRAL] Bye-bye, ma'am.