AccountId: 011433970860
ContactId: 4d7ccb67-dcd7-49e4-83fc-ef3a966c4e61
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 228070 ms
Total Talk Time (AGENT): 92723 ms
Total Talk Time (CUSTOMER): 62513 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/4d7ccb67-dcd7-49e4-83fc-ef3a966c4e61_20250404T16:53_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling from provider's office to check on the account.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] It would be my pleasure to assist you, and I'm sorry, what was your name?
[CUSTOMER][NEUTRAL] My name is [PII]. Last name initial is [PII]. Could you please spell your name?
[AGENT][NEUTRAL] My name is [PII] First initial of my last name is [PII].
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And [PII], what is a good callback number in case we get disconnected?
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Callback number is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] Policy number is 02539236.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] First name is [PII], the last name is [PII], [PII]
[AGENT][NEUTRAL] Date of birth.
[CUSTOMER][NEUTRAL] Oh, sorry. Date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] All right, thank you. And I understand you're needing claim status for [PII], and it would be my pleasure to assist you.
[AGENT][NEUTRAL] What is the data service?
[CUSTOMER][NEUTRAL] Date of birth is [PII]. Total charge amount of $1870 even 1870.
[AGENT][NEUTRAL] Thank you, [PII] and what is the facility name?
[CUSTOMER][NEUTRAL] The bottle of the Group LLC.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Now [PII], we did receive that claim on [PII].
[AGENT][NEUTRAL] And it was processed on [PII].
[AGENT][NEGATIVE] And this claim was denied.
[AGENT][NEUTRAL] As let's see.
[AGENT][NEUTRAL] The outpatient rider only allows payment for outpatient surgery in an outpatient hospital or physician's office. Therefore, there are no benefits payable.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] So it has to be for surgery.
[CUSTOMER][NEUTRAL] OK. Uh, we have built a claim with you.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] It would have to be for a surgical procedure.
[CUSTOMER][NEUTRAL] But we have billed the claim with the emergency code, right?
[AGENT][NEUTRAL] 99285.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, I'm pulling this claim, bear with me just one second.
[AGENT][NEGATIVE] It looks like this is for emergency room charges and there are no benefits for emergency rooms.
[CUSTOMER][NEUTRAL] The patient does not have emergency room benefits, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Go.
[AGENT][NEUTRAL] The call reference number is my name and today's date. Do you need that claim number?
[CUSTOMER][POSITIVE] I do have a claim. Sorry for that. Thank you.
[AGENT][POSITIVE] OK, no problem. It's been a pleasure to assist you with that claim information. Anything else I can help you with today?
[CUSTOMER][POSITIVE] That's all for now. Thank you.
[AGENT][POSITIVE] And thank you for calling APL Ron. Hope you have a wonderful day. Happy weekend.
[CUSTOMER][NEUTRAL] Mhm.