AccountId: 011433970860
ContactId: 4d26727f-6376-49bc-8863-4ff39169563c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 234740 ms
Total Talk Time (AGENT): 99958 ms
Total Talk Time (CUSTOMER): 85802 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/4d26727f-6376-49bc-8863-4ff39169563c_20250321T19:48_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 am calling on some claims that were denied.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I can assist you with that. May I ask your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the callback number, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the, do you have the same policy or different policies?
[CUSTOMER][NEUTRAL] Um, medical is true, yeah.
[AGENT][NEUTRAL] OK. And
[AGENT][NEUTRAL] What is, what is the policy number?
[CUSTOMER][POSITIVE] Good
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh, her I am calling from the provider's office and her policy number is 02538271.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And you said you, do you have more than one claim?
[CUSTOMER][NEUTRAL] Yeah, there's two this one, the first one's on for a consult and the other's for the surgery, and they're both for 12, 3 of 24.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And you have those claim numbers?
[CUSTOMER][NEUTRAL] I have the one, yes, uh, claim number 3553607.
[CUSTOMER][NEGATIVE] And the other one I misplaced in my pile.
[AGENT][POSITIVE] OK, no problem.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] So what is the build out for the other claim? I'll just go ahead and get them both pulled up and we'll take a look.
[CUSTOMER][NEUTRAL] $25,455.61.
[AGENT][NEUTRAL] Got it.
[AGENT][NEUTRAL] And what is the facility name?
[CUSTOMER][NEUTRAL] Suncoast Surgical Associates.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Just checking. OK, so for the um 99.
[AGENT][NEUTRAL] 284 for the.
[AGENT][NEUTRAL] $500.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That claim was denied because outpatient services are not covered under the patient's plan, so there's no facility benefits.
[CUSTOMER][NEUTRAL] OK, no outpatient benefits.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the.
[AGENT][NEUTRAL] Uh, 44,970 and 2900 that was denied because the maximum benefit had met was met for that data service, I think.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] for that day OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, is this like an indemnity plan?
[AGENT][NEUTRAL] It is.
[CUSTOMER][POSITIVE] It is OK.
[AGENT][NEUTRAL] It's a limited indemnity plan.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And do you want that other claim number? Uh.
[CUSTOMER][NEUTRAL] All right, can I get a reference number?
[CUSTOMER][NEUTRAL] Uh, no, I have it here somewhere just when I got on the phone, of course I couldn't find it.
[AGENT][NEUTRAL] I know how that goes. A reference number is going to be my name and today's date. I spell my name [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you very much.
[AGENT][POSITIVE] My pleasure to assist you with that claim information. [PII], thank you for calling APL. Have a great weekend.
[CUSTOMER][POSITIVE] Thank you you too bye.
[AGENT][POSITIVE] Thank you bye bye.