AccountId: 011433970860
ContactId: 7d8fbca8-cb87-4fd4-825d-35124497fcdc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 233860 ms
Total Talk Time (AGENT): 117599 ms
Total Talk Time (CUSTOMER): 64390 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/7d8fbca8-cb87-4fd4-825d-35124497fcdc_20250313T14:12_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, so my name is [PII] and I am calling about status on a claim.
[AGENT][NEUTRAL] OK, sure. I can assist you with claim status, Ms. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[CUSTOMER][NEUTRAL] [PII] and that's a direct line.
[AGENT][NEUTRAL] OK, thank you. And may I have the facility name where you're calling from?
[CUSTOMER][NEUTRAL] It's Augusta Health or Augusta Medical Center.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It is 02300416.
[AGENT][NEUTRAL] Thank you. And may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. May I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] And the bill amount is $898 even.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, let me see if I can find this claim, and that was [PII], correct?
[CUSTOMER][NEUTRAL] Yes, uh huh. [PII].
[AGENT][NEUTRAL] OK. And for the future, you can check claim status online through our website at [PII] and that's just optional. You can always call, um.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm waiting on the explanation of benefits. It's gonna be a minute, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, looks like we processed the claim on [PII] and let's see, it was denied. The reason for this denial is indicated that benefits payable under the certificate are limited to those outlined on the schedule of benefits.
[AGENT][NEUTRAL] So this is not a cover loss under the plan.
[CUSTOMER][NEUTRAL] Uncovered under the plan.
[AGENT][POSITIVE] Correct. Mhm.
[CUSTOMER][NEUTRAL] So he, he doesn't have um labs are not covered.
[AGENT][NEGATIVE] Correct, that are not covered under this policy for this member.
[CUSTOMER][NEUTRAL] Does it leave it to patient responsibility?
[AGENT][NEUTRAL] It's up to the provider's discretion. This one is a limited policy. It's not a major medical. So we don't know if he has any other policies out there. Um, so it's gonna be up to the provider's discretion. We don't have any contractual involvement on the remaining.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so not this is a limited policy, not a major medical policy.
[AGENT][NEUTRAL] Correct, yes, it's a limited policy. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alrighty, I think that's all I needed today. Can I get um a call reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name and today's date if you would like, Miss [PII], do you need the spelling of my name or any other information?
[CUSTOMER][POSITIVE] Yes, the spelling of your name would be great.
[AGENT][NEUTRAL] Yeah, sure. That's [PII], last initial [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much. I appreciate your help.
[AGENT][POSITIVE] You're welcome. No problem and thank you for calling APL. Have a good day, Miss [PII].
[CUSTOMER][NEUTRAL] You do the same. Uh-huh, bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.