AccountId: 011433970860
ContactId: 70208210-9a9e-459e-bfb9-181c01620e2e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 315260 ms
Total Talk Time (AGENT): 97753 ms
Total Talk Time (CUSTOMER): 100687 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/70208210-9a9e-459e-bfb9-181c01620e2e_20250204T18:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, yes, my name is [PII]. We now calling from those of checking and clients.
[AGENT][NEUTRAL] I'm so sorry I can not hear you very well.
[CUSTOMER][NEUTRAL] My name is [PII] calling from and claim status.
[AGENT][NEUTRAL] You said your name is [PII] and we're checking on a claim?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, sorry, it's a bit difficult to hear you um, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK and then do you have that policy number?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah, 02344794.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Uh, patient named [PII] date of [PII].
[AGENT][NEUTRAL] OK, I don't think I heard that policy number correctly, [PII]. Could you repeat that, please?
[CUSTOMER][NEUTRAL] 02344794.
[AGENT][NEUTRAL] OK, that was 479-4?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and if you would, could you repeat that, uh, patient's name and date of birth please?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, [PII], [PII].
[AGENT][NEUTRAL] Alright thank you for that [PII] what was the date of service for this claim please?
[CUSTOMER][NEUTRAL] Yeah, [PII], 27307 cents.
[AGENT][NEUTRAL] OK, I'm sorry, that was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what was that bill amount, please? I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, $273.07.
[AGENT][NEUTRAL] $273.07. OK, thank you one moment.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I put on the.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so we did receive this claim, [PII], we were unable to pay a benefit.
[AGENT][NEUTRAL] As treatment in an outpatient hospital is not covered by this policy.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] It does also not provide a wellness expense benefit.
[CUSTOMER][NEUTRAL] Mhm mhm
[CUSTOMER][NEUTRAL] So, our policy is not covered, right?
[AGENT][NEUTRAL] It's not covered. That's correct. If you'd like, I can send you a copy of this EOB.
[CUSTOMER][NEUTRAL] Sorry?
[CUSTOMER][NEUTRAL] No, if a claim is denied or?
[AGENT][NEUTRAL] I can send you a copy of the EOB if you'd like.
[CUSTOMER][NEGATIVE] No, no, no, the time is denied.
[AGENT][NEUTRAL] What was that? I'm sorry?
[AGENT][NEGATIVE] Yes, it was denied. It's not covered under this policy.
[CUSTOMER][NEUTRAL] The farm is the plan.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 1 2nd.
[CUSTOMER][NEUTRAL] What's the claim number?
[AGENT][NEUTRAL] Claim number is 3539654.
[CUSTOMER][NEUTRAL] What is the, uh, could you please spell your name?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] All reference number.
[AGENT][NEUTRAL] Reference number would just be my first name, last initial and today's date and my last initial is [PII] Was there anything else I can help you with?
[CUSTOMER][NEUTRAL] Uh, no, and what is the policy, actual, uh, uh, sorry.
[CUSTOMER][POSITIVE] One more. OK, thank you so much. Thank you.
[AGENT][POSITIVE] Yeah, thanks for calling APL bye bye.
[CUSTOMER][NEGATIVE] No, no.
[CUSTOMER][POSITIVE] Yeah, have a nice day. Bye bye.
[AGENT][POSITIVE] You too thank you.