AccountId: 011433970860
ContactId: 54951f8b-2a73-4306-bea4-92d7406a1f5a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 489089 ms
Total Talk Time (AGENT): 143623 ms
Total Talk Time (CUSTOMER): 87437 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/54951f8b-2a73-4306-bea4-92d7406a1f5a_20250117T19:00_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes ma'am, my name is [PII] and I'm calling from uh Lafayette Surgical Specialty Hospital wanting to check to see if y'all received the claim that we faxed.
[AGENT][NEUTRAL] OK, I can help you with the claim. Can you please give me your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Yes ma'am, [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And then what is the patient's name?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you and then what's [PII]'s uh policy number?
[CUSTOMER][NEUTRAL] 2483595
[AGENT][NEUTRAL] OK, let me look that policy up real quick.
[AGENT][NEUTRAL] OK, I found [PII]'s policy. Can you please give me the date of service?
[CUSTOMER][NEUTRAL] Yes ma'am, it is [PII].
[AGENT][NEUTRAL] And the charbo, yes.
[CUSTOMER][NEUTRAL] And the total bill amount is $123.95.
[AGENT][NEUTRAL] OK. And you said you're with Lafayette Surgical Center. Is that correct?
[CUSTOMER][NEUTRAL] Lafayette Surgical Specialty Hospital, yes, ma'am.
[AGENT][NEUTRAL] Specialty hospital, OK.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold Ms. [PII], while I look this claim up for you and I'll be right back.
[CUSTOMER][POSITIVE] OK thanks.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Alright, Ms. [PII], this is [PII] back with you again. So looking for [PII], um, looking for [PII] on data service 924 of 24. The claim number is 3534782.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim was denied with this remark, um.
[AGENT][NEUTRAL] The outpatient treatment benefit provides an indemnity amount when a covered person receives treatment in an emergency room, urgent care center facility, physician's office, or a physical, speech or occupational therapy facility. Treatment in an outpatient hospital less than 18 hours is not covered by this policy.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] So I guess the easy way would just say it's not covered.
[CUSTOMER][NEUTRAL] Yeah, yeah, OK, is there y'all send out a um notification stating that it's not covered?
[AGENT][NEUTRAL] We'll send an EOB, yes ma'am.
[AGENT][NEUTRAL] Let me see if one was.
[CUSTOMER][NEUTRAL] OK, can you tell me, yeah, when or tell me the process date something so I can have my dates together.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Yes, absolutely, absolutely, I can. OK, let's look, um.
[AGENT][NEUTRAL] OK, the claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it was processed on [PII].
[CUSTOMER][NEGATIVE] And have y'all send something out after the [PII] because we haven't received nothing.
[AGENT][NEUTRAL] OK, well what I can do for you is if you give me your fax number I'll send that to you right now while we're on the phone together.
[CUSTOMER][POSITIVE] OK awesome my fax number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold. I'm gonna send that fax right to you, Miss [PII].
[CUSTOMER][POSITIVE] OK thanks.
[AGENT][NEUTRAL] Do you, do you spell your name [PII]?
[CUSTOMER][NEUTRAL] Yes, that's fine.
[AGENT][POSITIVE] OK, all right, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi [PII], this is [PII] back with you again. I just wanted to let you know that I've got that fax on its way to you.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, sounds good um can I get a call reference number please, ma'am?
[AGENT][NEUTRAL] Yes, you can use my name [PII] and today's date.
[CUSTOMER][POSITIVE] Alrighty I will do that thank you so much I appreciate it.
[AGENT][POSITIVE] Thank you. You have a good weekend, Ms. [PII] and thanks for calling APL.
[CUSTOMER][POSITIVE] OK thanks too OK alright bye bye.
[AGENT][NEUTRAL] Mhm. Bye-bye.