AccountId: 011433970860
ContactId: 65a9e30e-9012-4534-a13f-130d6e17f75a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 222360 ms
Total Talk Time (AGENT): 88749 ms
Total Talk Time (CUSTOMER): 80073 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/65a9e30e-9012-4534-a13f-130d6e17f75a_20250304T20:10_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] Uh, my name is [PII]. I'm calling from [PII] office and I'm looking for a claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, [PII], and may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah. Contact number is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you for that and the member's policy number?
[CUSTOMER][NEUTRAL] And your policy number is 02510281.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, my first name is [PII] and [PII]. Date of birth is [PII].
[CUSTOMER][NEUTRAL] That's
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim and the total bills?
[CUSTOMER][NEUTRAL] Your date of service is [PII] and the total charge amount is $195 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yeah, Johnson City Medical Center.
[AGENT][NEUTRAL] Alright, so I'm showing we received the claim on [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] My claim number is 351-9566.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because this is not a covered loss under the plan, therefore, no amount payable, there is no amount payable for this expense. So it's not a covered charge.
[CUSTOMER][NEUTRAL] Non-covered under patient policy or mam uh provider contract?
[AGENT][NEUTRAL] On patients policy.
[CUSTOMER][NEUTRAL] No to.
[CUSTOMER][NEUTRAL] And may I know the uh which type of plant patient has?
[AGENT][NEUTRAL] Sure, hold on one moment.
[AGENT][NEUTRAL] So this is a hospital indemnity policy, so it's a limited medical policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So I need to be patient, right?
[AGENT][NEUTRAL] So we don't determine patient responsibility because we're not a major medical insurance company, um, that would just be whatever your policy is for outstanding remaining balances.
[CUSTOMER][NEUTRAL] OK. May I have a call reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII], my first name again is [PII]
[CUSTOMER][POSITIVE] OK, and uh thank you so much for providing the details. Have a nice day. Bye for now.
[AGENT][POSITIVE] You also, and thanks for calling APO. Bye-bye.