AccountId: 011433970860
ContactId: 683ad3a4-78b9-45ab-b122-f25e0cce4614
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 542039 ms
Total Talk Time (AGENT): 183845 ms
Total Talk Time (CUSTOMER): 130164 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/683ad3a4-78b9-45ab-b122-f25e0cce4614_20250130T20:03_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, [PII]. I'm Ay calling from provider's office. Sorry, can you please spell your name for me?
[AGENT][NEUTRAL] [PII] and how do you spell yours?
[CUSTOMER][NEUTRAL] My name, it's [PII], initial to my name, it's [PII].
[AGENT][NEUTRAL] And mine is also an S.
[AGENT][NEUTRAL] And Audi, how can I help you today?
[CUSTOMER][NEUTRAL] OK, I have a few questions on the claim.
[AGENT][NEUTRAL] You have one claim that you have questions on, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yes, I can help you with that and what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] No, sir. What is your phone number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, what is your phone number?
[CUSTOMER][NEUTRAL] Yeah, that's fine. It's [PII].
[CUSTOMER][NEUTRAL] [PII] and extension is [PII].
[AGENT][NEUTRAL] Start again, please. Yes, I need for you to start over with your phone number, please.
[CUSTOMER][NEUTRAL] That is the phone number. It's [PII]. My extension is [PII].
[AGENT][NEUTRAL] And the policy number, please?
[CUSTOMER][NEUTRAL] Policy number, it's D as in Delta.
[CUSTOMER][NEUTRAL] 437
[CUSTOMER][NEUTRAL] 31921.
[AGENT][NEUTRAL] OK, so that policy that number that you just gave me is for 90 degree benefits. That is not the APO policy number. Are you trying to reach 90-degree benefits or American Public Life?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so, actually, what happened is I already checked with 90 degree benefits. Uh, uh, can you please check with member's name and date of birth?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I can't search by the date of birth. I can try by the name. What is the last name?
[CUSTOMER][NEUTRAL] Last name, it's [PII], [PII]
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And the first name?
[CUSTOMER][NEUTRAL] First name it is [PII], that is [PII]
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information that I do provide for you will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, patient's name, it's as I said, [PII], and date of birth it's [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount?
[CUSTOMER][NEUTRAL] It is so it is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Total bill amount, please?
[CUSTOMER][NEUTRAL] And this for 386 $86 even.
[AGENT][NEUTRAL] Thank you. And the claim number?
[CUSTOMER][NEUTRAL] Uh, claim number, I don't have the claim number.
[AGENT][NEUTRAL] Oh, I thought you already, I'm sorry, I thought you had a question on the claim. OK, let me see if we have that claim on file. One moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so this claim was received on [PII] I'm sorry, just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim was received on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] The claim number is 353.
[AGENT][NEUTRAL] 9493.
[AGENT][NEGATIVE] This claim was denied.
[AGENT][NEUTRAL] And the reason for the denial on this claim and states the outpatient rider only allows payment for outpatient surgery in an outpatient hospital or physician's office. Therefore, no benefits are payable.
[CUSTOMER][NEUTRAL] Sorry, what did you say?
[AGENT][NEUTRAL] The outpatient rider only allows payment for outpatient surgery.
[AGENT][NEUTRAL] In an outpatient hospital.
[AGENT][NEUTRAL] Or physician's office. Therefore, no benefits are payable.
[AGENT][NEUTRAL] And that is the remark for both codes.
[CUSTOMER][NEUTRAL] Oh, so sorry. I, can you please just repeat it once more? I just need to document everything. So could you please, uh, repeat it once more, but a bit slow.
[AGENT][NEUTRAL] The outpatient rider.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Only allows payment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For outpatient surgery?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] In an outpatient hospital.
[AGENT][NEUTRAL] Or physician office.
[CUSTOMER][NEUTRAL] And then uh.
[CUSTOMER][NEUTRAL] You said in and out hospital.
[AGENT][NEUTRAL] I said in an outpatient hospital.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Or physician office.
[AGENT][NEUTRAL] Therefore,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] No benefits are payable.
[CUSTOMER][NEUTRAL] OK, so even this is not payable under providers, I mean on divisions plan, is that correct? That is 71046, OK.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. And what type of plan that member has?
[AGENT][NEUTRAL] This is a hospital indemnity limited benefit plan. It is not major medical insurance.
[CUSTOMER][NEUTRAL] So can we go ahead and list the patient since it's not covered under the patient plan?
[AGENT][NEUTRAL] We do not determine patient responsibility. That would be up to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you, ma'am. Can you please start with the reference number?
[AGENT][NEUTRAL] And if you need it, yeah.
[AGENT][NEUTRAL] Uh-huh, would be my name that I gave you along with today's date, [PII]. If you need a copy of the EOB, you can print it from our portal by going to secured. [PII], and you should be able to use that claim number I gave you.
[CUSTOMER][NEUTRAL] Uh, you said reference number it's.
[CUSTOMER][NEUTRAL] Your name.
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you, [PII]. Bye bye. Have a wonderful day.
[AGENT][POSITIVE] Yes, uh, you too, and thank you again for calling APL Aie if that's all I can help you with.
[CUSTOMER][NEUTRAL] OK, bye.
[AGENT][NEUTRAL] Um, bye-bye.