AccountId: 011433970860
ContactId: 55a406f6-ec59-472f-b3a6-e2ab182c6b7b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 262070 ms
Total Talk Time (AGENT): 83285 ms
Total Talk Time (CUSTOMER): 92412 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/55a406f6-ec59-472f-b3a6-e2ab182c6b7b_20250424T20:16_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII], and I'm calling for the provider to check on the additional information about that claim that has been denied. Please note this call will be monitored and recorded for quality and training purposes. It is [PII], my first name, it is [PII]. First name is last name, it is [PII].
[AGENT][POSITIVE] Thank you. I'm happy to check on a claim for you today. May I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, it is 02455926.
[AGENT][NEUTRAL] And do you have a good call back number?
[CUSTOMER][NEUTRAL] It is [PII] and it is a direct line.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient complete name is [PII]. Date of birth is on [PII].
[AGENT][NEUTRAL] And the data service.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And what was the bill amount?
[CUSTOMER][POSITIVE] Thank you. One moment, please. It is totally bill for about
[CUSTOMER][NEUTRAL] Sorry for the inconvenience. The total bill amount is $389.03.
[AGENT][POSITIVE] OK, thank you so much. One moment.
[CUSTOMER][NEUTRAL] I have two claims on file. Uh, please also verify that it is $389.05.
[AGENT][NEUTRAL] Do you have a claim number?
[CUSTOMER][NEUTRAL] Yes, the policy number I have on file, I mean, the claim number on file, it is.
[CUSTOMER][NEUTRAL] I'm showing the claim number is 358.
[CUSTOMER][NEUTRAL] 2929
[AGENT][NEUTRAL] OK, so I do show that we did receive this claim. Um, it looks like the claim received date was on [PII] excuse me, [PII].
[AGENT][NEUTRAL] A claim was denied. The outpatient benefits on the patient plan only allows for surgery in a hospital or physician's office.
[AGENT][NEGATIVE] Therefore, no benefits are payable.
[CUSTOMER][NEUTRAL] So outpatient benefits are available one, I mean, the for, we can say that the outpatient offices that are not covered under this patient's plan, is it correct?
[AGENT][NEUTRAL] Uh, no. So the patient plan permits for surgery and then outpatient in a outpatient hospital or physician's office only. So that was the reason for the denial. It was a place of service.
[CUSTOMER][NEUTRAL] We can say that based on this uh submitted claim, it's considered to be a non-covered service under the patient's plan. Is it correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] Thank you. Patience plan name, please?
[AGENT][NEUTRAL] Um, patient has a limited benefit.
[AGENT][NEUTRAL] Hospital indemnity plan.
[CUSTOMER][NEUTRAL] Thank you. May I get the caller reference number, please?
[AGENT][NEUTRAL] Call references my name with my last initial than today's date. My name again is [PII], that's [PII], last initial [PII] like [PII].
[CUSTOMER][POSITIVE] Got it. Thank you so much for your assistance on the past claim clarification today and have a great day.
[AGENT][POSITIVE] You as well. Take care.